PacificSource Health Plans

  • Manager, HS Program Mgmt and Strategic Planning

    Job Location US-OR-Bend
    Job ID
    2018-413B
    Type
    Regular Full-Time
    Hiring Pay Range
    DOE
    # of Openings
    1
    Status
    Exempt
  • Overview

    The Manager, HS Program Mgmt and Strategic Planning operates in a cross-functional role and has specific expertise in functional areas such as project management, healthcare/data analytics, business process outsourcing management, business analysis and process improvement management. The Project Manager is responsible for managing the entire life cycle of strategic initiatives and ad-hoc projects and ensuring that projects meet or exceed the success criteria as set forth by the business users. This position is also responsible for report development and distribution, either through code development or end-user generation. Report development includes defining business needs and interfacing with technical teams to develop end product.

    Responsibilities

    1. Work directly with the CMO to support Health Services, Pharmacy Services, Behavioral Health, and Quality to design, implement and evaluate operational programs and ensure alignment and simplification across lines of business.
    2. Ensure alignment with Health Services and Provider Network to improve contract strategies, implement quality and utilization metrics, and evaluate success.
    3. Responsible for data extraction, evaluation, and project recommendation and development.
    4. Manage assigned projects according to life cycle (define, plan, execute, monitor & control, review).
    5. Responsible for tracking and controlling a project’s budget.
    6. Develop and manage schedule; timelines, activities, milestones.
    7. Assess/analyze resource constraints/capacity and plans accordingly.
    8. Ensure/oversee complete requirements gathering and documentation.
    9. Creates and reports status to the necessary stake holders.
    10. Conducts regular team meetings on all projects.
    11. Monitor and maintains scope and/or solicits sponsor approval.
    12. Solicit team member collaboration on issues and problems.
    13. Identify appropriate project priorities and communicate to team members.
    14. Track project progress and communicate to team members and sponsor,
    15. Post regular project updates to website and other forms as defined by departmental procedures.
    16. Utilize Lean/process improvement methodology to achieve strategic goals.
    17. Presents projects and collaborates with various stakeholders.
    18. Supervises Health Services Project managers
    19. Coordinate business activities by maintaining collaborative partnerships with key departments.
    20. Actively participate as a key team member in manager/supervisor meetings.
    21. Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.
    22. Responsible for oversight, management, development, implementation, and communication of department programs.
    23. Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports. 
    24. Develop annual department budgets. Monitor spending versus the planned budgeted throughout the year and take corrective action where needed.
    25. Coordinate business activities by maintaining collaborative partnerships with key departments.
    26. Responsible for process improvement and working with other departments to improve interdepartmental processes.  Utilize lean methodologies for continuous improvement.  Utilize visual boards and daily huddles to monitor key performance indicators and identify improvement opportunities.
    27. Actively participate as a key team member in Manager/Supervisor meetings.
    28. Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy. 

    Supporting Responsibilities:

    1. Meet department and company performance and attendance expectations.
    2. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
    3. Perform other duties as assigned.

    Qualifications

    Work Experience: Five years health plan experience with varied clinical experience. Minimum of 5 years direct health plan experience in the following areas: healthcare information analysis; understanding of health care quality, claims and operations data, data collection and reporting to support health care improvement activities. Proficiency in computer and software programs: Microsoft Word, Excel, Powerpoint, and SharePoint.

     

    Education, Certificates, Licenses: Maintains current clinical and technical knowledge base and related functions. PMP preferred. Undergraduate or masters required.

     

    Knowledge: Understanding of health insurance as it relates in Medicare, Medicaid and Commercial lines of business as well as payment methodologies (fee for services, capitation, and blended). Understanding of health care operations in various clinical settings: primary care, specialty, hospital, ambulatory and post-acute.  Experience with HEDIS, QIM, NCQA and other quality initiatives. Knowledge of data analysis, utilization patterns and reporting.

     

    Competencies

    Our Values

    • Building Trust
    • Building a Successful Team
    • Aligning Performance for Success
    • Building Partnerships
    • Customer Focus
    • Continuous Improvement
    • Decision Making
    • Facilitating Change
    • Leveraging Diversity
    • Driving for Results

     

     

    • We are committed to doing the right thing.
    • We are one team working toward a common goal.
    • We are each responsible for our customers’ experience.
    • We practice open communication at all levels of the company to foster individual, team and company growth.
    • We actively participate in efforts to improve our many communities-internally and externally.
    • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

     

    Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 30% of the time.

     

    Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions.  Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

     

    Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

     

    PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

     

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