Risk Manager enhancing and maintaining Operational Risk Management Framework and Internal Control System at Piraeus Bank. Contributing to regulatory compliance and effective risk identification and assessment across the organization.
About the role
- Vice President of STARS and Risk Adjustment at Capital Blue Cross leading Medicare Star and Risk Adjustment Strategy. Collaborating with cross-divisional teams to optimize ratings and revenue in healthcare.
Responsibilities
- Lead enterprise efforts to optimize the Medicare CMS Star rating, ACA Quality Rating System, and optimize risk-adjusted revenue in all risk adjusted market segments.
- Develop a multi-year strategy in collaboration with organizational stakeholders including Medical Affairs, Member Services, Network Operations, Compliance, Process Improvement, Pharmacy and other critical business units as necessary to drive process change across the organization to improve performance.
- Develop roadmap that defines the path to operationalize specific actions which are repeatable, measurable, and cost-effective.
- Collaboration with analytics team to measure the effectiveness of initiatives and process improvements.
- Coordinate with existing vendors, and/or identify and implement new vendors, in order to drive desired outcomes in quality-based metrics, and risk adjustment activities.
- Lead, coach and instruct process owners and improvement teams in the definition, documentation, measurement, improvement and control of processes aimed at optimizing the quality of the Medicare and ACA programs.
- Create and lead cross-departmental initiatives to change processes to increase the effectiveness of the member experience with the goal of ensuring continued persistence in enrollment and to avoid early disenrollment based on plan dissatisfaction.
- Evaluate the effectiveness of existing operational metrics, developing new metrics as necessary, to better assess the performance of organization in achieving quality, revenue, and satisfaction targets.
- Gather member experience data and conduct analysis to identify gaps, opportunities and performance trends.
- Utilize information to drive member behavior towards those actions that are expecting to improve health outcomes.
- Track and report on the progress of all Star and Risk initiatives to various levels within the organization to ensure transparent understanding of the opportunities, risks and successes of efforts across the organization.
- Develop a company-wide Star education program that can be easily delivered via digital tools.
- Support individual units with unit specific training if needed to support key STAR metric understanding.
- Directs the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive training and support
- Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.
- Perform other duties as assigned.
Requirements
- A minimum of seven (7) years work experience in progressively increasing leadership roles in a corporate environment, including at least five (5) years of direct management experience
- Experience in quality assurance processes, industrial engineering concepts, or continual improvement
- Demonstrated ability to manage complex, high-profile assignments involving both people and business issues where there are time and budget constraints
- Expert-level collaboration skills and group facilitation skills with all levels of the organization
- Executive- and Board-level written and oral communication skills to establish and maintain positive relationships with all levels of the organization
- Ability to influence organizational change
- Make decision by processing information quickly and assessing alternatives (often based on incomplete data)
- Documented and proven examples of delivering cost savings at a macro-level
- Demonstrated track record of success, implementing new strategies in a complex environment, with an ability to analyze, assess and respond to enterprise needs with impactful solutions.
- Demonstrated leadership ability exemplified by; capacity to think strategically and implement tactically to consistently deliver results; well-developed skills in diplomacy and collaboration.
- Demonstrates the drive, determination, and perseverance to get things done
- Builds solid relationships in 360 degrees within the Company, as well as with customers, vendors, and other Blue Plans
- Demonstrated ability to develop and lead high performing and collaborative teams.
- Ensures staff have access to development opportunities both educationally and experientially in order to proactively prepare to support developing business expectations
- Innovates new ideas, tools, and approaches related to process evaluation and re-engineering
- Champions change with an eye to the future in order to position the company to be responsive to market pressure.
Benefits
- Medical, Dental & Vision coverage
- Retirement Plan
- generous time off including Paid Time Off, Holidays, and Volunteer time off
- Incentive Plan
- Tuition Reimbursement
- and more.
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