Clinical Innovations Specialist - 21538904
Responsible for assisting Clinical Operations leadership with the design, implementation, and monitoring of performance improvement initiatives. This position is specifically intended to support the organization's ability to identify and implement new business initiatives related to care management and utilization management designed to improve quality, outcomes, and member satisfaction, while reducing costs. In the process of achieving these intended outcomes, the individual in this position will be identifying new opportunities for other initiatives, evaluating the cost and benefits of various alternative solutions, communicating actionable findings and recommendations to senior/ executive management, and then leading the initiative implementation, ultimately monitoring the effectiveness of the implementation.
- Assist Senior and Executive leadership in the identification of performance improvement opportunities within Clinical Operations aimed at improving member health outcomes, reducing inappropriate utilization, and increasing both quality and member satisfaction.
- Perform research and analysis to determine scope, feasibility, and impact of implementing initiatives. Provide actionable recommendations, create executable roadmap for process redesign and implementation, and identify methodology and metrics for measuring success and monitoring outcomes.
- Manage initiatives aimed at the re-engineering of operational processes to improve efficiencies within the department, including but not limited to care/case management and utilization management.
- Re-engineer operational processes by streamlining workflows, improving system functionality, increasing value-add activities and interventions.
- Builds criteria to systemically evaluate both qualitative and quantitative attributes of new solutions implemented to ultimately measure results and drive additional recommendation to Senior and Executive Management
- Define scope and size of new solutions to inform executable roadmap for implementation and process redesign
- Key contributor to critical departmental documentation, including policies, procedures, process maps, training materials, and audit tools.
- Represent the department through participation in organization-wide strategic initiatives, collaborating with other operational areas to ensure successful implementations
- Provide strategic project leadership and management in implementation of new solutions and capabilities
- Self-motivated and able to work collaboratively as a member of a team as well as on one’s own as needed.
- BA/BS – Bachelors Degree or equivalent required. MA/MS - Masters Degree or equivalent strongly preferred.
- 5-8 years related experience required.
- Proficiency in Microsoft Office: Excel, Word, Access; Lotus Notes; Internet.