Clinical Practice Lead/Vice President - Healthcare/Pharmacy/Critical Care/Nursing/Utilization Management (16-28 yrs)

MANDATORY ASK:

Min 16+ years of overall experience with minimum of 8+ years in a corporate role leading clinical practice/strong operational & strategic insights on pharmacy, nursing, critical care, etc/good understanding of tools & technologies in this space/open to working us shif

PURPOSE:

The role of a global leader in business process management and member/patient experience, combines technology-powered services with decades of healthcare domain expertise to drive positive outcomes.

The purpose of the role is to be able to "Execute the Vision/Drive the Road Map as per our strategic roadmap for Clinical Practice Management."

STRATEGIC SKILLS:

- The Practice Leader for the Clinical Practice Leader will report into the Sr. VP, who is responsible for successfully creating a centre of excellence in alignment with the industry for all delivery parameters and also successfully grow the overall practice revenues. The Clinical Practice Leader will support all practice objectives.

- This position is collaborative with other extended Clinical product/ service/ delivery suites and is continuously aligned to market changes by utilizing enterprise assets.

- The ideal candidate is a 50% thinker and a 50% do-er accountable for both conceptualizing and delivering new ideas translating into marketable opportunities for the organisation.

- The Practice Leader for the Clinical Practice Leader will report into the Sr. VP, who is responsible for successfully creating a centre of excellence in alignment with the industry for all delivery parameters and also successfully grow the overall practice revenues. The Clinical Practice Leader will support all practice objectives.

- Execute the Vision/Drive the Road Map as per our strategic roadmap for Clinical Practice office.

- Works with key stakeholders to execute the long-term vision and develop the roadmap for a differentiated and competitive offering in the marketplace

- Communicates the Practice development roadmap (short, mid and long term) on a regular basis to both internal and client audiences

- Coordinates with key stakeholders including Delivery, Solution, Sales, SAM leads with the goal of creating a 'seamless, integrated, consistent" user experience across relevant products

- Work with other staff and key stakeholders to identify the best way to execute the new solutions, with primary focus over, Utilization management.

GO TO MARKET:

- Builds and maintains a detailed view of competitive offerings, making sure that the sales team is fully briefed, and that Practice strategy is developed with a detailed view of competing offerings.

- Works with finance and sales to manage and adjust pricing based on market conditions and profitability goals.

- Works across the organization to champion the Clinical Practice and find ways in which the business can bring value to a broader audience.

- Works with the Training Dept. to develop and deliver training on new Clinical practices and capabilities.

- With Legal, develops contract templates that accurately define SOW, standard delivery terms, invoicing, etc.

- Working with marketing, helps to develop and update sales materials, web pages, presentations and RFP responses.

CORE FUNCTIONAL SKILLS:

Support all clinical service delivery done offshore in the Utilization management, care management and clinical front office and back-office scope for healthcare (Payers and Providers) and workers comp products. The support will be in the following areas:

- Support all Clinical opportunities for growth from current clients and new prospects with regards to RFP.

- Be available for all clinical opportunities and be able to collaborate with the teams to provide superior quality of solution design and value proposition plan to new prospects.

- Attend all client meetings and present the clinical capabilities, innovation, and application of such innovation to client specific processes.

- Support all new clinical process transition with re to hiring, training, and in meeting all Service levels including but not limited to TAT, quality, and productivity expectations as per the contractual agreement.

- Work closely with vendors in clinical talent management and helping with a steady sourcing mechanism that is both cost and talent effective.

- Works closely with operations, WFM, Business excellence and training functions in building standard practices across all delivery parameters across delivery geos- in alignment with industry leaders and market requirements.

- Be available for all Monthly Business reviews, quarterly business reviews with clients for all clinical processes onshore and as needed for offshore accounts and represent the practice view points on market trends and innovations and solution sets.

- Proactively engage with business transformation teams and operations teams to identify innovative solutions that can help either improve experience or reduce cost per review in all UM related functions including prospective, retrospective, concurrent reviews, and appeals reviews.

- Keep track of market movement and the key gaps in capabilities to support the market and thereby support achieving the revenue target from newer capabilities in the Clinical practice, year on year.

ONGOING SALES/MARKETING SUPPORT:

- Must have a clinical degree (MD/USRN/Physical Therapist).

- Additional qualifications preferred- MBA.

- Unrestricted license to practice within the United States is nice to have.

EDUCATION:

- Acts as a Subject Matter Expert for the sales and client services teams, attends sales calls, demonstrates the products, helps to answer deep questions about the product and works to convince the client we have the best solution.

EXPERIENCE:

- 8+ years in a corporate role leading Clinical practice (in the capacity of sales support, business transformation, Clinical Product development or a client account partner, Experience mapping technical solutions to business and process outcomes for the client.

- Experience developing business plans for solution portfolio.

- Minimum of 5 years' experience working with a health plan or large health system preferred.

- Minimum of 3 year of management experience, including hiring, training, assigning work and managing performance of staff.

FUNCTIONAL/TECHNICAL KNOWLEDGE, SKILLS & ABILITIES REQUIRED:

- A background that includes strong clinical work, experience in managed care and managing a clinical program or clinical call centre team in the medical management functions with ability to understand, interpret and apply complex federal and state health care compliance laws, rules, regulations, and organization and industry-based policies, procedures, and guidelines.

- Understand and interpret clinical reports and support process improvements with opportunity identification and coordination of improvement plan in collaboration with other teams such as operations, business excellence and business transformation.

- Should be biased to action with result-oriented approach in a collaborative manner with all functional teams.

- Working knowledge of NCQA, and health plan requirements related to utilization management.

- Excellent computer skills, utilization management and/or case management software. Proficiency in Word, PowerPoint, Excel. Experience in analysis of utilization and quality management data.

- Able to resolve conflicts and/or negotiate with others to achieve positive results; establish and maintain effective interpersonal relationships. Demonstrates resourcefulness, diplomacy, organizational and analytic skills. Able to work effectively and collaboratively with interdisciplinary teams.

- Highly organized, self-directed and able to work independently under general direction and minimal supervision; able to assume responsibility, take initiative, follow up on assignments, make appropriate decisions within the scope of the position, handle multiple projects simultaneously in a high-volume work environment and assume accountability for own decisions and aware of when to escalate issues to management.

- Adaptable to a rapidly changing environment and to keep supervisor informed of any delays which could disrupt delivery of health care services or internal operations.

- Ability to develop and implement educational materials and presentations for all levels of learners.

- Maintains member information in a confidential manner and ensures HIPAA compliance at all times.

- Proficient in speaking, reading, and writing English is required. Ability to effectively communicate clearly in both verbal and written format.

- Ability to effectively present information and respond to questions among a variety of audiences, including patients, providers, internal and external managers, health plan representatives, and vendors in the community.