Strategic Advancement Associate Vice President

2 weeks ago

Honolulu, Hawaii, United States CLevelCrossing Full time
Job Title: Associate Vice President Strategy Advancement

At CLevelCrossing, we are seeking an experienced Associate Vice President Strategy Advancement to join our team. This role will be responsible for leading functions related to our Care Management programs, including predictive models, engagement strategies, intervention, and corresponding support. The successful candidate will also lead Utilization Management, including Policy, Appeals & Denials, and integration with Claims adjudication.

Key Responsibilities:
  1. Develop and execute strategic plans to meet our company's strategic objectives and key results while leading both our team and cross-functionally to gain alignment and execute.
  2. Oversee four departments, including Case Management, Disease Management / Personal Nurse, Utilization Management / Appeals, and Experience and Optimization team, and grow directors and associate directors.
  3. Develop, challenge, and grow direct and indirect reports to capitalize on our company's talent through building developmental plans at a 95% compliance rate for Supervisors and above, ensure succession plans are in place for all leaders, and actively promote self-learning opportunities to improve business and leadership acumen.
  4. Create a culture of innovation, collaboration, and high-performance operations by organizing and leading cross-functional teams to advance our company's objectives.
  5. Identify opportunities to improve the beneficiary experience, operational performance, and/or financial performance, gain Executive Committee approval, and build multi-disciplinary teams.
  6. Lead complex transformational changes that require strategic planning / visioning, leading cross-functionally to gain buy-in and then execute through extensive project planning, significant resources, and broad coordination across our company and Humana (if applicable) to advance our company's mission, support strategic objectives, and promote our company's brand.
  7. Meet contract deliverables and contract performance guarantees at a 99% rate on a monthly basis.
  8. Develop leading operational metrics that ensure contract deliverables and performance guarantees are met.
  9. Develop and deliver on process improvement initiatives that help our company maintain a competitive cost and performance position, reduce operational & contract risk, improve operating outcomes for our company, and build capacity for new capabilities.
  10. Know the TRICARE Operating Model within Medical Management so it may be fully leveraged for future business opportunities while also identifying opportunities to apply leading industry and Humana practices within our company.
  11. Serve as the strategic and operational subject matter expert for the designated responsible functions while also focusing on our company's overall strategy.
  12. Collaborate with Humana and our company's leaders to share and obtain lessons learned for consistency and quality across multiple contracts and business lines.
  13. Drive innovation internally within the team and identify innovative opportunities for application in our company and Medical Management.
  14. Identify, communicate, and prioritize IT and Analytics projects that support complex problems / operations that have a longitudinal impact within our company.
  15. Evaluate and adapt to contract change orders, communicate change orders to applicable teams, identify required resources related to the change order, and modify processes to meet government requirements.
  16. Execute the guidance and vision provided by senior our company's and Medical Management leadership.
  17. Serve on the Executive Committee as a contributor and advisor to develop our company's strategic objectives, improve our company's performance, ensure initiatives do not compromise morale and well-being of the associates, and mitigate operational and contractual risk.
  18. Represent the VP, Medical Management Operations as required.
Requirements:
  1. Bachelor's Degree.
  2. Graduate degree in relevant field, business or health care administration preferred.
  3. 10 years of leadership experience in Government Contracts, Business Development, Management, Medical Operations, or other relevant/related experience.
  4. Experience in Military or Government healthcare preferred.
Knowledge, Skills, Abilities:
  1. Excellent written and verbal communication skills at multiple levels.
  2. Ability to apply the principles of independent logical thinking to define problems, collect data, establish facts, draw valid conclusions, and make strategic recommendations.
  3. Ability to integrate and coordinate content from various sources to establish deliverables for multiple stakeholders and hold others accountable for delivering.
  4. Ability to synthesize information from a variety of resources to present or address an issue or to answer a question.

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