Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care.
G.E.H.A has one mission: To empower federal workers to be healthy and well.
Manages the operations of internal and external clinical, cost containment and population health programs and ensures quality patient care and cost-effective utilization of resources for members and dependents across the continuum of care. Develops and monitors program goals consistent with the department strategic plan. Develops, maintains, and reviews internal and external reporting and audit results to measure program and staff performance. Manages mobilization and engagement of staff needed to accomplish department and corporate goals. Manages integrated care processes as well as clinical interventions to support HEDIS performance. Identifies program gaps and opportunities, recommends action, and deploys staff to implement programs and improvements. Facilitates multi-discipline teamwork across departments to implement new initiatives or resolve issues affecting the department. Responsible for management of budget for assigned programs and staff.
SKILLS
Duties and Responsibilities
- Provides operational oversight of internal/external care management and utilization management programs including Inpatient and Post- Acute services in both clinical and business domains. Reviews programs for clinical integrity and compliance with organization and regulatory requirements. Ensures appropriate management of high dollar cases or high dollar populations and interventions that will drive appropriate use of resources and improved patient care.
- Ensures quality patient care and cost-effective utilization of resources. Develops clinical interventions to drive continuous improvement of population health outcomes, including HEDIS and CAHPS. Understands and insures the use of evidence-based guidelines and industry-accepted utilization management protocols. Drives team compliance with department workflows.
- Develops program goals consistent with department and company strategic plan. Ensures goals are measurable and reportable. Assists teams to understand the business, clinical, and financial impact. Monitors goal performance and drives teams to accomplish goals.
- Develops, maintains, and reviews internal and external reporting and audit to measure program and staff performance. Analyzes information, solicits team input, and evaluates effectiveness of programs. Ensures accuracy of reporting and timeliness of reports incorporated into executive level reporting.
- Manages the mobilization and engagement of clinical and nonclinical staff to accomplish department and corporate goals. Maximizes the use of team strengths to accomplish work. Identifies opportunities to shift or realign work of individuals or team’s work to maintain interest and engagement. Manages the hiring, promotion, reassignment of subordinates and oversees the disciplinary actions.
- Identifies program gaps and opportunities, recommends action, and deploys staff to implement programs and improvements. Identifies opportunities for the development of new care management approaches and prepares the business case with cost analysis, IS requirements, education and implementation plan. Recommends new technology or software that may enhance program performance and/or contribute to staff efficiencies or patient quality.
- Facilitates multi-discipline teamwork across departments to implement new initiatives or resolve issues affecting the department. Develops relationships with key stakeholders in other departments and collaborates in the development of project plans and solutions.
- Responsible for management of budget for assigned programs and staff. Participates in the preparation of budget for assigned programs. Monitors monthly expenditures and explains variances.
- Manages the performance and disciplinary actions for assigned staff. Evaluates and determines need for disciplinary action, manages the disciplinary action process for assigned team.
Requirements: Knowledge, Skills, and Abilities
- Requires a bachelor’s degree healthcare, healthcare payer, or wellness related field.
- RN with equivalent years of experience will be considered.
- 5 years clinical experience.
- Requires 3 years of managerial experience.
- Requires strong analytic and problem-solving capabilities.
- Ability to identify solutions and recommendations that effectively address business and control needs along with how to train and guide others in this area.
- Requires the ability to effectively communicate (oral and written) and direct area staff.
- Strong analytical ability to solve complex problems. Must possess advanced interpersonal skills to effectively interface with all levels of staff as well as external business-related associates.
- Knowledge of Microsoft Office.
- Requires the ability to multi-task effectively, responding to changing business priorities and deadlines.
- Requires the ability to work collaboratively with team members across multiple divisions and departments.
Work-at-home requirements
- Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office.
- A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required.
- Latency (ping) response time lower than 80 ms
- Hotspots, satellite and wireless internet service is NOT allowed for this role.
- A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
How we value you
- Competitive pay/salary ranges
- Incentive plan
- Health/Vision/Dental benefits effective day one
- 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution
- Robust employee well-being program
- Paid Time Off
- Personal Community Enrichment Time
- Company-provided Basic Life and AD&D
- Company-provided Short-Term & Long-Term Disability
- Tuition Assistance Program
While this is a remote opportunity, at this time G.E.H.A does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, Maine.
Please note that the salary information is a general guideline only. G.E.H.A considers factors such as (but not limited to) scope and responsibilities of the position, candidate’s work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer.
The hiring range for this position is $97,618 - $123,493 USD. At G.E.H.A, the current maximum salary for this role is $137,606 USD. While initial compensation may vary based on experience and qualifications, there is a path to work toward this top rate through performance and continued growth within the organization.
G.E.H.A is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. G.E.H.A will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees.
G.E.H.A is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.
