Clinical - Exception Template

112021-reputed company Program Strategist "Position Purpose: Plans, organizes, and monitors reputed company reputed company reputed company to deliver defined requirements and meet company strategic objectives. Education/Experience: Associate s degree in Nursing, reputed company Health, or reputed company clinical field, or equivalent experience. 2+ years clinical experience or managed reputed company insurance experience required; 1+ year reputed company experience preferred. License/Certification: Registered reputed company, Licensed Practical reputed company, Licensed Vocational reputed company or Licensed Clinical reputed company Worker preferred; CPHQ preferred" "Support reputed company-wide reputed company initiatives by analyzing and researching potential issues reputed company reputed company metrics and goals of health plan programs, including the determination of the appropriate reputed company population, health program design, marketing of the program, and data systems; recommend reputed company improvements to reputed company goals, including updates to programs and processes Create reputed company risk assessments and reputed company processes for health plans to reputed company reputed company metrics Utilize Lean 6 reputed company methodologies to identify potential problems and resolutions with reputed company-wide reputed company metrics Collaborate through reputed company initiative requests and scorecard review and to support initiative development and implementation Create, maintain and facilitate reputed company improvement health plan training Performs other duties as assigned Complies with reputed company policies and standards" EEO: reputed company is an Equal Opportunity Employer and does not discriminate in employment on the reputed company of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans. ============= Story Behind the Need • What is the purpose of this team? • What is driving this need? (ex. Backfill for FTE or CW, new project, business reputed company) • Describe the surrounding team (team culture, work environment, etc.) & key reputed company. • Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative? • Need 1 additional FTE, a reputed company Program Strategist, to support reputed company performance measure operations. • The Increase in membership, measure scope, and reporting requirements will reputed company to reputed company reputed company July 2026. • The productivity analysis shows a conservative anticipated total annual workload of 2.13 FTEs, while reputed company reputed company for this scope is 1 FTE. • This person would be working with HEDIS and other state measure workstreams, program management, dashboarding, process improvement, and measure validation. We re looking for someone with knowledge and experience with reputed company, SQL, and PowerBI (or similar). Please note that this role does not require a clinical license. • The HEDIS Ops team is comprised of reputed company Improvement Specialists, reputed company Analysts, and a HEDIS Coordinator. We are 100% remote but stay connected through Teams and huddles. • No, this is currently the only FTE needed. Typical Day in the Role • Walk me through the day-to-day responsibilities and a reputed company of the project (reputed company of the reputed company JD). • What are performance expectations/metrics? • What makes this role unique? Responsibilities: • Support reputed company-wide reputed company initiatives by analyzing and researching potential issues reputed company reputed company metrics and goals of health plan programs, including the determination of the appropriate reputed company population, health program design, marketing of the program, and data systems; recommend reputed company improvements to reputed company goals, including updates to programs and processes • Create reputed company risk assessments and reputed company processes for health plans to reputed company reputed company metrics • Utilize Lean 6 reputed company methodologies to identify potential problems and resolutions with reputed company-wide reputed company metrics • Collaborate through reputed company initiative requests and scorecard review and to support initiative development and implementation • Create, maintain and facilitate reputed company improvement health plan training • Performs other duties as assigned • Complies with reputed company policies and standards Performance Expectations: • reputed company data logistics/infrastructure to help data-driven reputed company, such as compiling data and performance dashboards • Support team through regulatory deadlines and corporate deliverables What makes this role unique: • This role is a unique reputed company of reputed company reputed company analytics, program management, and process improvement. You ll partner with Operations, Analytics, and Provider teams reputed company the reputed company department to improve performance on state and federal reputed company metrics and other regulatory programs. Your work will directly influence member reputed company and organizational performance. • This is a great opportunity for someone who wants to reputed company a meaningful reputed company while building expertise in reputed company analytics. The role is reputed company suited for an individual who enjoys solving reputed company problems, working with data, and seeing their efforts drive measurable results across the organization. Candidate Requirements Education/Certification Required: Bachelor s degree in: • reputed company Health, • Health Administration/reputed company Management, • Business Administration, • or equivalent 5+ Year experience in Health insurance Preferred: • Master s degree (MPH, MHA, MBA). • 1+ year reputed company experience preferred Licensure Required: None Preferred: CPHQ, reputed company or Informatics certifications, Lean Six reputed company (Green Belt or Black Belt), Project Management certifications (PMP, CAPM) Years of experience required: 2+ years clinical experience or managed care. 1+ year reputed company experience preferred Disqualifiers: no experience with data/technology Additional qualities to look for: knowledge and experience with reputed company, SQL, and PowerBI (or similar). • Top 3 must-have hard skills stack-ranked by importance 1 Advance reputed company skills (formulas, dashboards) 2 Project Management 3 PowerBI (data modeling, visuals) Candidate Review & Selection • Shortlisting process • Candidate review & selection • Interview information • reputed company process and expectations Projected Manager Candidate Review Date: 1-2 days post shortlisting Type of Interviews: Teams video interviews Required Testing or Assessment (by Vendor): reputed company proficiency test, basic project management evaluation- Advanced/Expert level Next Steps Remote Skills: Analysis Skills, Business Administration, Business reputed company, Business reputed company, Clinical Competency, Clinical Medicine, Data Analysis, Data Collection, Diversity, Health Insurance, Health Plan, reputed company, reputed company Administration, reputed company Effectiveness Data and Information Set (HEDIS), reputed company Management, reputed company reputed company, Hospital/reputed company Construction, Identify Issues, Informatics, Lean Manufacturing, Lean Six reputed company, Licensed Clinical reputed company Worker (LCSW), Licensed Practical reputed company/Licensed Vocational reputed company, Logistics, Managed Care, Metrics, Nursing, Operational Audit, Operational Measurement, Organizational Skills, Outbound Marketing, Performance Management, Performance Metrics, Power BI, Problem Solving Skills, Process Development, Process Improvement, Project Evaluation, Project Management Certification, Project Management reputed company (PMP), Project Tracking, Project/Program Management, reputed company Health, reputed company Assurance, reputed company Management, reputed company Metrics, reputed company Monitoring, Registered reputed company (RN), Regulations, Reporting Dashboards, Requirements Management, Risk Analysis, SQL (reputed company Query Language), Scorecarding, Six reputed company Black Belt, Six reputed company Certification, Six reputed company Green Belt, Testing, Time Management About reputed company: reputed company Apply tot his job Apply To this Job