Please note, this individual will be required to visit our DC office, one day per week.
Summary:
Provides strategic leadership and innovative practices for the Federal Employee Program, aiming to reduce care delivery costs while improving quality metrics. Oversees FEP's medical/surgical benefit management, including value-based care, case and disease management, and mental health services. Advises stakeholders, enhancing plan engagement, and promoting health equity. This role focuses on developing clinical programs, analyzing health outcomes, managing population health, and fostering a culture of excellence, teamwork, and continuous learning. Additionally, it includes mentoring staff to build a positive, collaborative work environment.
What you will do:
- Direct the creation and development of case and disease management strategies, mental/behavioral health programs, utilization management, and medical-surgical coding to boost engagement, outcomes, and operational efficiency; ensure uniform program delivery nationwide, work on cost containment, and promote health equity; guide cross-functional teams to execute clinical initiatives and streamline claims and invoice processing.
- Collaborates cross-functionally to launch equity initiatives, develop programs, recommend system changes, and create performance metrics; ensures alignment across delivery systems for new clinical products and services; oversees administration, compliance, and stakeholder readiness for complex benefits and clinical programs.
- Provides leadership and expertise for FEP and BCBSA initiatives, guides innovative clinical and quality health outcomes initiatives, ensures consistent delivery of clinical services across vendors, and represents clinical interests in benefit proposal negotiations with the Office of Personnel Management.
- Lead and manage a team with the aim of driving effective performance management, fostering professional growth, and creating a positive and inclusive work environment. This role is dedicated to utilizing strong leadership and communication skills to motivate and inspire team members, ensuring they are aligned with and committed to achieving the organization’s goals.
What you will need:
- Required Bachelor's Degree in allied Health, Pharmacy or Business or equivalent work experience. Clinical degree a plus (RN, MSN, RPH, PharmD, MD, LPN)
- 12+ Years health Plan experience (or equivalent clinical experience)
Knowledge Skills and Abilities:
- Technical proficiency with information technologies (e.g. Microsoft Office)
- Experience rolling out new programs and operational experience in managing programs and budgets
- Understanding of health care/managed care industry and environment including health care issues, reform, competition, ancillary provider trends and MCO industry trends
- Excellent interpersonal skills and ability to work with and within a cross-functional team environment
- Ability to work within all levels of organizational and government and vendors
- Excellent verbal, presentation and written skills as well as the ability to establish and manage multiple priorities
- The ability to gain various viewpoints and arrive at critical decisions to ultimately develop and implement strategic initiatives
- Proven ability to lead motivate and organize teams and knowledge
- Technical proficiency with information technologies (e.g. Microsoft applications, Winframe, account management and group ware) to enable the management of on-going communication
What we can offer:
- Financials-$172,000-220,000 + Annual Bonus and potential sign on. -this is based on years of experience.
- 401 (k) company match up to 7% (after 1st year completed)
- We offer a competitive health care plan-2nd week after initial hire date.
- And much more.
