Job #: 1264
Title: Director of Clinical Partnerships
Momentum is looking for a Clinical Director.
The Fund is seeking a Director of Clinical Partnerships. The successful candidate will be responsible for overseeing the day to day provider-related operations and strategic planning that support the Fund’s programs to deliver cost effective and high quality health care coverage to its plan participants. This position reports to the Health Fund’s Director.
Essential Duties and Responsibilities:
· Develop and manage relationships with area hospitals in order to provide Health Fund participants with access to high-quality, cost-effective care.
· Collaborate with the Health Fund leadership to design and implement benefit changes that focus on quality and bend the health care cost curve without shifting costs to members.
· Manage protocols for responding to inquiries and complaints received from providers and Fund participants specific to hospital-based care.
· Act as a liaison between the Fund and its Third Party Medical/Hospital Administrator to resolve inquiries and complaints from providers and members about claims and network participation.
· Supervise the Clinical Manager who negotiates out-of-network bills for emergency services
· Supervise a continuous quality improvement program that determines operational targets, measures performance, and improves program outcomes. As needed, advise Fund management about systematic problems that pertain to members and the providers from which they seek care.
· Coordinate resources with other Fund departments to efficiently deliver benefits.
· Assist with the development and implementation of special projects which are meant to improve health outcomes and reduce the cost of providing health benefits.
The ideal candidate is someone with both project management/operations experience in a health care setting as well as experience working with physician networks. Qualifications include:
· Minimum of seven (7) years of relevant experience in a health care or health plan setting, with progressive levels of responsibility and a track record of consistent quality and efficiency improvements.
· Demonstrable knowledge and understanding of the health care delivery system.
· Strong leadership skills, combined with an ability to work well independently and well as part of a team.
· Excellent communication skills, both oral and written, demonstrated by an ability to coordinate and communicate with internal and external contacts.
· High degree of analytical skills demonstrated through extensive experience analyzing data, identifying problems, and recommending solutions.
· Evidence of sound problem-solving and decision-making skills for resolving participant, and provider issues, processing, and workflow issues.
· Well organized, attentive to detail and able to multitask and manage projects.
· Ability to plan and successfully implement program initiatives in a timely manner.
· Ability to prioritize work and meet deadlines.
· Able to proficiently use MS Office software packages.
· College degree- BS or BA. An MBA, MPH, or MPA a plus.