UNITE HERE HEALTH serves 190,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!
The Sr. Director of Medical Cost Management will develop and oversee the Medical Cost Management plan for Aurora Plans. This position will lead organization efforts to monitor medical and pharmacy cost trends and develop action plans to address identified gaps or opportunities.
ESSENTIAL JOB FUNCTIONS AND DUTIES
- Develop and oversee the Medical Cost Management plan for the Aurora plans to include payment integrity, high-cost claims, complex bill review, high-cost members, data integrity, medical specialty, network management, utilization management, pharmacy, population health and other areas
- Lead organizational efforts to monitor medical and pharmacy cost trends, and identify actions to achieve medical and pharmacy cost improvements spanning network and clinical programs
- Develop action plans to address identified opportunities, including researching industry standards, vendor solutions and the build requirements for internal solutions
- Partner with Claims, Analytics, Underwriting, and Clinical teams to implement best-in-class methods to systematically identify and manage medical cost drivers
- Utilize historical, predicted, and competitive market data to recommend benchmarks for setting expectations for, and measuring, financial and operating performance (KPIs)
- Develop metrics, reports and models to enable effective monitoring and analysis of network, condition management, site of care, and unit cost improvement programs
- Collaborate with enterprise data and technology partners to ensure the company’s data strategy supports program performance monitoring and stakeholder reporting needs
- Build strong relationships within the organization including Executive VP’s, Claims, Clinical Operations, Underwriting, and Analytics
- Help establish an appropriate staffing model, including internal and new hires, to build an effective team to manage various areas
- Establish and maintain a cross-functional organizational and operating model to effectively set and accomplish shared goals and objectives
- Plans, analyzes, and evaluates programs and services, operational needs, and fiscal constraints
- Supervises, leads, and delegates work and coaches, mentors, develops employees
- Analyzes problems, identifies, and develops alternative solutions, projects consequences of proposed actions, and implements recommendation/solutions
- Recommends hires and promotions, directs, and evaluates employment decisions for all assigned positions
- Assists with developing and coordinating policies and procedures
- Responsible for the oversight of continued employee training requirements, safety, and quality initiatives
ESSENTIAL QUALIFICATIONS
- 10+ years of direct experience in healthcare finance, healthcare consulting, network analytics or analysis on healthcare data minimum
- 5 ~ 7 years of team management experience
- Working knowledge and experience in building, leading and growing teams
- Experience presenting to senior leadership, both internally and externally
- Experience with reporting and metrics on healthcare data
- Proficiency working with query, business intelligence and statistical tools
- Proficiency in financial modeling and financial analysis needed to determine ROI in decision-making processes
- Bachelor's degree in Finance, Statistics, Mathematics, Analytics or related field or equivalent work experience required (Master’s degree in Business Administration or Science or related field preferred)
- The ability to travel 15% - 25%
- Managed care experience, preferred
Salary range for this position: Salary $176,200 - $229,100. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.
Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) as a remote role, plus 15% – 25% travel requirement.
We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Pension, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).
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