Director of Healthcare Payer Solutions
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The Director of Health Payer Services is responsible for the successful planning and execution of a strategic and tactical plan to provide services to health solutions payer clients in meeting short- and long-term business and technology strategies and objectives. The Director of Health Payer Services reports to the Managing Director of Health Payer Services and directs the work of the Health Solutions Payer Group. In addition, the Director provides sales support, solution creation, and delivery management oversight. This individual will be responsible for expanding the scope of the Health Solutions Payer Practice and setting overall objectives for the group.
External Focus: The focus of this position will be to assist our clients in the following areas:
Develop service solutions based on clients’ consumer strategies, with the objective of solving business problems and improving customers’ staff, member and solution provider experiences.
Provide leadership to the client team in performing analytic and strategic consulting engagements to ensure that all deliverables provide clients with a measurable return on investment.
Assess and deploy processes and tools to effectively enable regulatory compliance and business optimization.
Understand market forces, trends, performance and impacts of state and federal-level healthcare payer requirements and incentive programs, especially the business/operational impacts of adoption.
Understand how client efforts fit within the overall initiatives of other stakeholders (providers, vendors, clearinghouses).
Assess client projects for areas of risk, including identification of gaps and recommended areas for improvement.
Facilitate large-scale meetings and workshops with client stakeholders.Manage vendors to meet compliance with contractual obligations.
Understand the impacts of regulatory changes on reimbursement and coding trends.
Develop architectural solutions surrounding mandated changes.
Utilize organizational, industry and competitive knowledge to help clients achieve meaningful, sustainable business results and desired outcomes.
Establish reporting and information management processes to support business development and to meet local, state and federal reporting requirements related to incentive programs and legislative activities.
Maintain in-depth knowledge of competition, along with market segments and overall trends.
Analyze and facilitate information technology systems which support organizational objectives, including strategic systems planning, selections, optimizations, and re-sizing.
Manage evolving client expectations, needs, and priorities at the senior level, including C-Suite.
Develop and nurture senior-level client relationships.Incorporate and encourage collaboration and buy-in by client stakeholders.
Turn regulatory compliance measures into a strategic advantage.
Internal Focus: The Director of Health Payer Services will perform the following functions:
Create high-margin, repeatable programs and new methodologies that deliver measurable value-add services and solutions for our clients.
Evangelize and support sales efforts of new programs.
Build and manage a team of ten or more strategic solutions senior consultants.
Provide expertise in named areas through individual and team consulting engagements.
Utilize functional knowledge expertise and industry-standard methodologies and tools, as well as creative problem-solving abilities to devise solutions related to training, change management, and program management.
Effectively utilize the marketing and talent acquisition organizations in order to maximize brand recognition and fulfillment/staffing objectives.
Develop and communicate strategy and tactical/operating plans to management.Achieve yearly revenue targets.
Successful executive leadership experience (VP or C-suite level).
Demonstrated success in executive program leadership in full lifecycle, enterprise-wide implementation(s) of high technology applications in payer environments.
Prior experience as a CIO supporting a large healthcare payer organization preferred.8 or more years’ experience in healthcare payer consulting.
Ten years of progressive IT management experience or a combination of education and experience in an IT environment, preferably in a professional services/consulting organizationExceptional leadership, organizational and project management skills.
Familiarity with one or more health plan management systems.
Hybrid background of technical and clinical skill sets preferred.
Understanding of healthcare industry service delivery processes in a multi-facility payer system.
Experience with oversight of multiple simultaneous complex projects.
Previous leadership experience with management of multimillion-dollar project budgets.
Managerial experience supervising and managing a large staff of consulting professionals and technicians.
Demonstrated ability to solve highly complex technical, organizational and operational problems.
Experience in establishing and maintaining appropriate and effective project governance structures for large, complex organizations.
Demonstrated ability to communicate, collaborate and consult effectively with all levels of an organization in a matrixed environment.
Demonstrated knowledge of outcomes management and process improvement methods.
Demonstrated understanding of enterprise-wide healthcare payer applications suites.
Proven change agent and mentor.
Willingness to travel extensively, typically on a Monday through Thursday basis.
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