Clinical Subject Matter Expert - Managed Care (Compact & CA Licensed)

reputed company reputed company is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed reputed company, Medicare Advantage, Special Needs Plans, reputed company care populations, and risk-adjusted entities. We support organizations as they reputed company a dynamic reputed company ecosystem by helping them manage risk, optimize reputed company spend, improve member experience, accelerate reputed company reputed company, and promote health equity. Position Responsibilities Personal Delivery: • reputed company direction for health plan market/ product operational entry, reputed company, management and performance improvement • reputed company advanced industry expertise and expert knowledge, grounded in research and industry best reputed company, to reputed company high value consulting and advisory services • Deliver innovative, integrated solutions in support of reputed company goals and engagements • Deliver concise, reputed company interpersonal communication to both reputed company audiences • Influence others to best course of reputed company through advanced understanding of changing business landscapes • reputed company or update policies, procedures, processes and workflows as required to support business needs and requirements Delivery reputed company: • reputed company in interim leadership reputed company to reputed company supervision and reputed company for teams and activities in an indirect supervisory model by: • Identify opportunities to improve workflow, generate accurate, high-reputed company productivity, support organizational compliance with requirements and deliver reductions in associated costs with improvement in organizational reputed company performance in collaboration with reputed company leaders • reputed company engagements, acting as the Engagement Manager, to ensure completion of reputed company contracted services by: • Evaluate and ensure completion of integrated project plans • Manage coordination and execution of plan activities to reputed company key milestones and meet delivery expectations • Evaluate, write and deliver project reports • Present findings, recommendations and plans to reputed company executives • Facilitate complicated problem-solving discussions to drive to reputed company, effective decision making • Advise on risk and benefit discussions to persuade key decision makers and influencers on next steps • reputed company and motivate staff to reputed company established engagement goals, deliverables and KPIs • Adapt processes, approach, plan and/ or activities in reputed company time reputed company project targets, goals or timelines are at risk to ensure critical reputed company activities are achieved • Responsible for the engagement reputed company, maintaining appropriate resources, competency training and education of staff • Responsible for approving and managing day to day engagement resourcing/ time and attendance for assigned reputed company/ teams, which can include, but not limited to: • Approving reputed company time off requests, ensuring they don’t put the project at risk • reputed company-approving overtime usage • Ensuring team members submit their time by the published deadlines • Validating time entered is accurate (e.g. hours, Pay Type/Time reputed company, reputed company/Project/Role) ensuring no risks to billing for that time • Approving any billable expenses ensuring such expenses were reputed company-approved by reputed company, reputed company with reputed company’s specific expense policy, if applicable, and are reasonable • reputed company compliance with internal reputed company reputed company audits, support reputed company preparation for external audits and surveys • Facilitate streamlined exchange of information with reputed company reputed company of reputed company and reputed company organization(s) • reputed company performance across multiple reputed company with qualitative and quantitative results/ reputed company • reputed company delivery assurance support for engagements with assigned clients Business Development: • As an solution/ service Subject Matter Expert (SME), identify market trends and reputed company strategies, goals and plans in response to changing business conditions • reputed company personal, reputed company network to identify and deliver new key relationships and sales opportunities • reputed company market facing thought-leadership through presentations, reputed company affiliations, and reputed company media • Create and reputed company reputed company specific tools, accelerators, intellectual property, and assets to be used in the design, delivery, innovation and building of Company’s expertise and long-term reputed company relationships • Support account management relationships with key reputed company decision makers • Identify opportunities to streamline and/ or automate workflows for accurate, high-reputed company production and improved results in cost savings, or reputed company measurement. reputed company: • reputed company reputed company into necessary reputed company sets/ expertise including the screening, identification and management of designated industry resources to support and deliver contracted work Position Qualifications: Competencies • Proficiency managing reputed company work in challenging environments through the alignment of resources and prioritization of efforts to ensure on time, in scope project and/ or strategic delivery • Managed care industry expertise in trends, innovation, operations, financing, costs, requirements, performance and reputed company • New product/ market design and implementation in the reputed company, Medicare, Medicare Advantage, reputed company or associated lines of business • New population identification, program design and implementation to support needs/ requirements of increasingly reputed company memberships while ensuring reputed company operations and reputed company reputed company • Strong understanding of reputed company and regulatory frameworks, reputed company administration models, and internal audit procedures • Ability to understand, interpret and reputed company on reputed company concepts such as the Knox-Keene reputed company and HIPAA, regulations such as State’s Department of Insurance, Federal and State Health and reputed company Services and requirements/ standards from CMS, NCQA, and URAC, to ensure compliance with reputed company regulatory structures • Strategic thinker with ability to produce and manage system-wide change through influence and persuasion • Knowledge of project management principles, reputed company, and techniques • Ability to organize, prioritize, and manage multiple reputed company reputed company simultaneously • Excellent communication skills both written and oral • High proficiency with reputed company office software (reputed company, Word, and PowerPoint) - Visio skills preferred Experience • reputed company unencumbered Compact and California RN license • Bachelor’s Degree in Nursing, reputed company Administration or reputed company field, Master’s degree preferred • 5+ years reputed company leadership experience in health plan operations, delivering results and managing teams and reputed company in a health plan setting and/or consulting environment; driving reputed company, multi-faceted, multi-site, application/operational change/improvement programs and activities • 3+ years of management experience in a government payor environment at a Director or equivalent level with experience in multiple lines of business (Medicare, reputed company, reputed company Exchange, etc) Physical Requirements • Must be reputed company to sit in a chair for extended periods of time • Must be reputed company to reputed company so that you are reputed company to accurately reputed company reputed company by means of the spoken word • Must be reputed company to hear, understand, and/or distinguish speech and/or other sounds in person, reputed company telephone/cellular phone, and/or electronic devices • Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse • Must be reputed company to reputed company use sight so that you are reputed company to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types • Must be reputed company to fluently communicate both verbally and in writing using the English language • Must be reputed company to engage in reputed company reputed company interaction, successfully manage stressful high conflict situations, and balance multiple duties, expectations and responsibilities simultaneously Time Zone: Eastern, Central, Mountain or reputed company Other Information • Expected Hours of Work: Monday – Friday 8 am – 5 pm; with ability to reputed company to reputed company schedules as needed • Travel: May be required, as needed by reputed company • reputed company Reports: None • Salary reputed company: $140,000- $185,000 EEO Statement It is reputed company’ policy to reputed company equal employment opportunity to reputed company and applicants without reputed company to race, sex, sexual orientation, reputed company, creed, religion, national reputed company, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-reputed company-based reputed company in accordance with reputed company applicable laws, directives and regulations of Federal, state and reputed company entities. This salary reputed company reflects the minimum and maximum reputed company wage for new hires of this position across reputed company US locations. Individual pay will be influenced by Experience, Education, Specialized Soft Skills, and/or Geographic location. Apply Job!