Requisition ID: 1363
Location: Dempster Corporate
2380 East Dempster, Des Plaines, IL 60016 United States (US)
Daily Hours: No Selection
Standard Hours: 8:00 am to 5:00 pm
Employment Status: Full-time
Employment Type: Regular
Reporting directly to the President, this role will lead the strategic oversight and management of the Health Services (Clinical Operations) Teams, which will include Utilization Management and Care Coordination. This role will collaborate with the CMO/PHP Senior Leadership to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets, while creating a sustainable platform for the evolution of population health. Development, engagement and management of the Health Services Team to deliver effective and efficient standards, protocols, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operations functions and promote quality cost effective health care for PHP members. Partner with key stakeholders within PHP and the Presence Health enterprise to meet annual healthcare cost and quality targets for the health plan. They will model the behaviors and attributes of an executive skilled at navigating an ambiguous environment under rapid change; held to strict regulatory and ethical standards; measured on service and performance outcomes; motivated to lead an engaged Division; and driven by the mission of its faith-based Sponsors.
They will also serve as a member for various System Council's, providing an important leadership connection between PHP and the enterprise.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Judge specific organization activities and ensure activities contribute to organization's success
- Analyze detailed information to generate and utilize multiple types/sources of data for use in decision-making at all levels
- Challenge ideas and offer innovative, constructive points of view
- Demonstrate the highest level of professionalism and leadership as a key member of the senior leadership team and representative of PHP
- Work independently and remotely at a variety of locations across the geographic coverage area of PHP Plans
- Strong communication and team/interpersonal skills.
- Strong leadership capabilities and ability to initiate and maintain cross-team relationships.
- Ability to meet Quality Accreditation Standards (NCQS/HEDIS)
- Ability to meet established deadlines
- Organizational and management skills
- Analytical problem solving capabilities
- Excellent verbal and written communication skills
- Ability to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
Education and/or Experience
- Master's Degree in Business Administration, Health Administration, or related field
- Ten years of progressive healthcare leadership experience that includes direct experience in operations, managed care and clinical operations
- Worked within applicable state, federal and third party regulations
- Operational and process improvement experience preferred
- Microsoft Office Suite
- Knowledge of and ability to manage expert users of database software
- Experience with analytical modeling software; budget and finance platforms, internet software, spreadsheet software, and graphics software
Business Unit: Presence Health Partners
EOE of Minorities/Females/Vets/Disabled