About the position
Responsibilities
• Maintain operational excellence through matrixed leadership and oversight of centralized medical management functions.
• Serve as the subject matter expert in medical management operations, including Utilization Management, Care Management, and Quality integration.
• Ensure the organization understands Illinois’ needs, compliance benchmarks, and timelines.
• Oversee the analysis, management, execution, and staffing for all health services operations impacting the health plan.
• Provide oversight of the Quality team’s activities to ensure optimal performance with HEDIS and accreditations.
• Act as the single point of contact on health services operations between the health plan and regulators.
• Represent the health plan as the health services SME for all Plan-specific RFP activity.
• Lead and partner with the COO on clinical program vendor implementations.
• Capture and communicate internal clinical initiatives to ensure a cohesive clinical strategy.
• Identify compliance processes needed to meet Medicaid standards and ensure timely quality reviews of reports.
• Present complex concepts to various levels of leadership within the organization.
• Serve as point of contact for all health services operations and meet with external stakeholders as needed.
Requirements
• 10+ years of experience in medical management leadership roles including leadership within managed care organizations.
• 5+ years of Medicaid experience, preferably in the State of Illinois.
• Experience with data analytics reporting and analysis used to help serve managed care populations.
• Experience presenting executive level presentations to various internal and external audiences.
• Strong influencing skills to effectively work across a wide range of senior stakeholders to drive alignment and results.
• Extensive experience leading cross-functional initiatives and driving innovation.
• Experience working with varying levels of contacts, including executive leadership and external state officials.
• Demonstrated success in collaboration, teamwork, and execution across multiple departments to deliver results.
• Strong decision-making, analytical and organizational skills.
• Ability to develop and execute strategic and tactical business plans.
• Ability to exercise sound business judgment to achieve proper balance between objectives and stakeholder engagement.
• Demonstrate a commitment to diversity, equity, and inclusion through continuous development and modeling inclusive behaviors.
Nice-to-haves
• Registered Nurse, preferably in the state of IL.
• Illinois state resident.
• Interaction with the state regarding Medicaid programs, contract requirements, reporting, and deliverables.
Benefits
• Full range of medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan available for eligible employees.
• Fully-paid term life insurance plan for eligible employees.
• Short-term and long-term disability benefits.
• Numerous well-being programs and education assistance.
• Free development courses.
• CVS store discount and discount programs with participating partners.
• Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year.
