Health Equity & Community Investments Program Development Specialist I/II (Finance)

Job Description:

The HE/CIP Program Development Specialist I-II supports the health equity and community investments strategic plan, goals, enterprise-wide measures, and efforts to achieve improvement across our markets and populations. This work includes supporting the implementation of a structured health equity education initiative for all health plan stakeholders; the development of a robust health equity data infrastructure; the use of quantitative and qualitative health equity data analysis of all established programs, clinical care and community health outcomes over time and against our targets; and the establishment of effective clinical interventions. The Specialist conducts ongoing review, research, and analysis of health equity strategy. The incumbent creates comprehensive strategic proposals based on in-depth research of best practice initiatives, leveraging both internal and external resources available, to ensure the health plan remains an innovator in this space.

Essential Accountabilities:

Level I

• Partners with leadership on sharing and updating a robust health equity and community health training initiative that spans the entire enterprise as well as externally.
• Research and maintains sound knowledge of health equity, evidence-based improvement interventions, industry trends, best practices, and benchmarks to deliver innovative and effective solutions for the management of the health equity strategy.
• Consults on the development of the health equity data infrastructure to ensure appropriate creation of downstream clinical interventions to mitigate health disparities.
• Manages the ongoing roadmap execution as well as measurement of success of implemented interventions on a clear cadence and appropriately intervenes to ensure success.
• Serves as a clinical SME for the Health Equity and Community Investments (HE/CIP) team. Serves as a clinical SME in addressing and identifying health disparities and SDOH through clinical analyses.
• Facilitates processes needed to analyze and improve processes and workflows. Organizes and facilitates large educational and re-engineering sessions. Facilitates interdepartmental coordination and communication with all Care Management functional areas, such as, but not limited to Case Management, Utilization Management, Behavioral Health, Medical Claim Review and Audit, Health Promotion, Disease Management, to support delivery of high quality, timely customer solutions.
• Consults with key internal stakeholders including medical directors, operational and strategic leadership, SMEs, and regional directors as well as external network/other Blues plans regarding the nature of the opportunity identified, potential interventions, and desired and expected outcomes.
• Evaluates initiatives and determines key benchmarks in collaboration with health equity stakeholders for its use in subsequent evaluations.
• Analyzes, compiles and implements interventions to incorporate into strategic assessments; creates comprehensive strategic proposals to improve health outcomes. Collaborates with other departments early in the initiative development cycle including quality, provider engagement, customer care, VBP programs, corporate communications/marketing, clinical operations, and others, in regard to cross-functional business processes, program development initiatives and timelines.
• Collaborates with the Quality department to facilitate health equity accreditation requirements.
• Consults with the CIP team to incorporate a community-based approach on projects, processes and initiatives.
• Assesses member, provider and other key stakeholders' experience related to new or updated initiatives and plans proactively to address their concerns and needs positively.
• Oversees vendor relationships associated with vendor partners as needed, including identification of key vendors, nurturing vendor contacts, RFI/RFP creation and strong oversight, pricing negotiations, contract facilitation with legal and other entities, monitoring vendor SLAs/PGs as needed.
• Provides reports and recommendations to the Utilization Management/Case Management (UM/CM) team for action. Responsible for defining, coordinating, and communicating the ongoing monitoring of existing programs in HE/CIP and other areas as relevant to ensure meaningful intervention outcomes and value are realized and partner with key stakeholders to support strong results. Serves as subject matter expert in maintaining the UM/CM training program for PHE and other key stakeholder roles.
• Represents Medical Services on Health Plan-wide cross functional process improvements teams, as requested by manager/director. Coordinates HE/CIP committees to define, prioritize and facilitate initiatives, as appropriate.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Level II (in addition to Level I Accountabilities)

• Participates in, facilitates, and may manage all aspects of meetings within HE/CIP and in support of program development as needed.
• Mentoring and coaching of program development team within the department and others in similar roles as appropriate.
• Provides input and recommendations into strategic proposals for program development team.
• Acts as an ambassador of the team function throughout the organization to ensure consensus, collaboration, and support.
• Provides presentations to key stakeholders to share the vision and mission of the HE/CIP team and build awareness, support, and participation for the process and team.

Minimum Qualifications:

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels

• Minimum of two (2) years experience working within a health plan related to Health Equity/ Population Health Management or other clinically related program development with Bachelor's degree in related field.
• In lieu of a degree, minimum of eight (8) years experience working within a health plan in a role related to population health management/case management interventions/programs or other clinically related program development required.
• Five (5) years of clinical experience required.
• PMP certification preferred.
• Working knowledge of best practices and tools related to project management and process engineering/improvement Working knowledge of Corporate Medical Policies, InterQual and Milliman & Robertson guidelines, NCQA standards, URAC requirements, HEDIS, CMS requirements, and NYSDOH medical management mandates & program requirements.
• Demonstrates effective verbal communication skills and strong writing capabilities.
• Developing skills in reading, analyzing and understanding analytics reports and documents.
• Understands basic concepts of return-on-investment measurement. Exhibits excellent organizational, planning, and project management skills. Makes decisions using solid judgment skills to impact identified problems.
• Resourceful and appropriately tenacious in the face of varied opinions to gain consensus.
• Exhibits leadership through meeting facilitation.
• Subject matter expert on the development of clinical strategic interventions.

Level II (in addition to Level I Qualifications)

• Minimum of six (6) years' experience working within a health plan in a role related to utilization management/case management interventions/programs or other clinically related program development.
• Strong understanding of and preferred experience with Return-on-Investment measurement and concepts.
• Experience with process development and refinement, experience leading projects whether formal or informal. Reads, analyzes, and understands complex analytics reports and documents. Able to identify further areas of exploration/opportunity and guide analytic requests to explore targeted opportunities.
• Demonstrated strengths with emotional intelligence including keen collaboration, consultative relationship building, and consensus building skills.

Physical Requirements:

• Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.
• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• Ability to work in a home office for continuous periods of time for business continuity.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
• Manual dexterity including fine finger motion required.
• Repetitive motion required.
• The ability to hear, understand, and speak clearly while using a phone, with or without a headset.
• Must have a valid Class D license and ability to operate a motor vehicle.

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One Mission. One Vision. One I.D.E.A. One you.

Together we can create a better I.D.E.A. for our communities.

At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know inclusion of all people helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating all of our employees' experiences, skills, and perspectives, we take action toward greater health equity.

We aspire for our employees' interests and values to reflect the communities we live in and serve, and strongly encourage all qualified individuals to apply.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing an inclusive workforce, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

E2: $60,410 - 96,081

E5: $71,880 - $129,384

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.