Director of Clinical Performance Improvement

Position Summary:

The Director of Clinical Performance Improvement, reporting to the Sr Director, Clinical Operations and Performance, is responsible for establishing approprpiate clinical and financial benchamarks and targets, measurement against those targets, variation identification, and solution development for that variation. The role works collaboratively with Finance, Actuarial, Medical Economics, and Clinical Operations to ensure that monitoring of key performance measures is aligned and integrated in all programs, operations, and intiaitives. This role will use existing reporting or create new reporting to continuously monitor health plan trends and variation in medical expense, utizliation, and unit cost and then working with appropriate stakeholders to close variation gaps when identified. This role also serves as a critical liaison in translating analytics into actionable insights and performance plans.

Supervision Exercised:

Yes, which includes but is not limited to providing leadership, work direction, and performance feedback to subordinate staff.

Essential Duties & Responsibilities:

• Actively monitor health plan medical expense, utilization, and unit cost year over year trends, performance against targets, to identify key areas of variation driving
• Review the performance of Clinical Operations and their direct impact on medical expense and utilization
• Guide teams in translating insights into operational action, with a focus on execution, measurement, and continuous improvement
• Monitor the clinical and financial performance of individual health plan benefits and products
• Identify key performance indicators (KPIs) and be a key leader in annual utilization and medical expense targets to ensure alignment with clinical operational capability and capacity.
• Maintain a collaborative relationship with Finance, Medical Economics, and Actuarial to ensure proper medical expense and utilization budgetary targets are set at an achievable level on an annual basis
• Identify the most appropriate and accurate benchmarks for CCA's populations and health plan products as it relates to medical expense and utilization. Actively scan the market for new benchmakrs and targets for CCA.
• Through the use of established reporting, analytics, and dashboards identify actionable variation in medical expense, utilziaiton, and unit cost given the current state of clinical operations, capacity, and capabilities.
• Monitor all the performance medical expenses and clinical operations against thresholds and targets to identify areas of opportunity for reduction
• Develop recommendations for products, programs, and initiatives that further the affordability of medical benefits and health plan expenses.
• Support the development of medical management initiatives to ensure overall clinical effectiveness.
• Search for external solutions that focus on address medical expense variation while complimenting CCA's core clinical competencies.
• Responsible for tracking and reporting to Senior Leadership the performance and identified variation of all medical expense reduction initiatives
• Develop dashboards and executive summaries to communicate clinical and financial impact of initiatives
• Develop medical expense monitoring and medical expense reduction initiative reporting as needed
• Perform detailed data analysis when appropriate using a variety of analytical techniques
• Own and manage performance monitoring processes or ad-hoc projects

Working Conditions:

• Standard office conditions.
  

Required Education (must have):

• Bachelor's Degree in management, analytics, finance, or other related field

Desired Education (nice to have):

• Master's Degree

Required Experience (must have):

• 5-8 years of experience in performance management and improvement or managerial experience in business administration
• Prior health industry experience is essential.

Desired Experience (nice to have):

• Health Insurance Experienced preferred
• Experience with health plan clinical functions: care management and utilization management

Required Knowledge, Skills & Abilities (must have):

• Superior analytical skills using a variety of qualitative and quantitative data
• Ability to analyze clinicial, claims, and financial data; draw conclusions, and make appropriate recommendations
• Exceptional problem solving across a wide range of business situations
• Ability to understand, interpret and help drive the division's end-to-end business model
• Ability to analyze complicated business problems with minimal direction and clearly communicate findings to a range of stakeholders
• Excellent written and oral communication skills
• Strong interpersonal skills
• Comfort with presenting findings in a team environment or to senior leadership
• Ability to prioritize and work on multiple projects simultaneously
• Ability to manage multiple high-profile projects
• Proven ability to interact and develop relationships with stakeholders in multiple departments

Required Language (must have):

• English