Medical Cost Transformation Leader

EmblemHealth Job Opportunity

Research, develop, recommend, implement, monitor, and report on strategies to create self-funded client value, bending the medical cost curve, and reducing administrative cost burdens. Lead the identification, business case development and implementation of high impact clinical initiatives. Inform and develop clinical strategies to achieve annual financial goals with executive stakeholder agreement. Monitor ROI for medical cost trend reduction programs.

Principal Accountabilities

• Establish the medical cost strategy for medium and high valued cost initiatives using in depth internal and external information to enable executive decision making.
• Lead the high valued initiatives from business case development and stakeholder agreement through stabilization and ongoing ROI monitoring phases cross functionally.
• Lead financial business case development for new high value initiatives along with ongoing performance assessment of current initiatives.
• Direct opportunity analyses aimed at driving strategic revenue targets, innovating in the clinical care space, supporting initiatives to lead process efficiencies, and to determine the best course of action for a medical cost reduction strategy.
• Support vendor assessments to determine the true value of a proposed solution.
• Lead projects to completion through effective process mapping and collaboration with financial projections and analysis.
• Develop clear, articulate, actionable business cases targeted towards executive audiences, post implementation stabilization monitoring strategy, ROI monitoring strategy.
• Prepare executive level materials for presentations to enterprise leaders and decision makers.
• Provide the clinical leadership team with definition of program-level strategy to achieve medical cost savings targets.
• Provide concept and tactical knowledge and support to the assigned implementation managers through implementation and organizational readiness.
• Ensure appropriate principles of change management are in use, along with performance metrics and dialogs / committees.
• Ensure that appropriate corrective actions plans are deployed, including monitoring / measuring effectiveness.

Qualifications