OH Market Program Management Director; Managed Care

The OH Market Duals Program Management Director assists the Vice President, Duals Products with oversight of program implementations, compliance oversight, operational performance, program growth, clinical and care management effectiveness, Quality and Affordability Initiatives (QAI) pipeline development, and execution of other activities which support program management effectiveness and successful delivery on operational budget and other performance commitments.

• Responsible for leading Duals Program Management Operational activities across the OH Market from both a Program Management and Business Analysis perspective
• Establish strategies and goals to identify and mitigate program risks
• Identify and assist with the rapid resolution or escalation of program issues, blockers, and hindrances
• Evaluate market-specific operational process effectiveness for accomplishing market goals and objectives; manage operational process improvement activities in collaboration with Enterprise, Duals, and Market Teams
• Integrate continuous improvement and innovation into all projects and initiatives
• Develop, translate, and execute key strategies for functional/ operational requirements
• Incorporate industry standards, best practices, project management tools and techniques to support market initiatives
• Recognize and proactively manages operational dependencies and risks across Duals product initiative portfolio through effective change and risk management controls
• Lead activities ensuring the delivery of high quality, consistent initiatives that result in optimum outcomes for OH members, providers, and program goals
• Monitor performance across markets duals programs to leverage best practice and knowledge sharing for the purpose of improving outcomes through the standardization of evidence-based practices
• Assess, manage, and control program scope, schedule, and budget change impacts
  
  Work closely with business executives to ensure assigned programs align with business strategy and are properly funded, resourced, and managed
• Drive cross-functional communication between impacted business and IT areas
• Facilitate and drive program stakeholder meetings
• Represent program in governance meetings
• Review and approved program meeting minutes
• Interact with Integrated Dual Programs, market, and other program business partners, and build strong working relationships with key staff across market and enterprise operations
• Engages stakeholders to ensure alignment
• Provide leadership and support for product expansion
• Perform any other job related duties as requested.

• Bachelor's degree in project management, business, public health or related field required
• Master's degree preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Six (6) years of government-regulated (Federal and/or State) health insurance products including Medicare, Medicaid, Managed Care Waiver, and FFS required
• Six (6) years of project and program management experience required
• Five (5) years of experience driving performance and process improvements in the health care insurance industry required
• Demonstrated experience implementing programs with focus on integration required

• Strong healthcare payer industry experience, including knowledge of Medicaid, Medicare, and government-regulated products
• Comprehensive operational knowledge across member and provider functions, clinical operations, and sales/business development
• Deep understanding of project management processes, tools, techniques, development life cycles, and project management software
• Ability to manage large, complex projects from start to finish, including budgets up to $10M+, cross-functional teams, core members, and multiple vendors
• Strong organizational, time management, prioritization, and execution skills to deliver projects on time, on budget, and aligned with stakeholder expectations
• Excellent analytical, reporting, decision-making, problem-solving, critical thinking, and critical listening skills
• Ability to identify business problems, assess solutions, shape approaches, gain consensus, and understand business partner and stakeholder needs
• Excellent written and verbal communication skills, with the ability to interact effectively with all levels of leadership and internal/external stakeholders
• Strong relationship-building, interpersonal, leadership, training, teaching, and change agent skills
• Ability to work independently…