Clinical Process Improvement Director

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Director, Clinical Process Improvement will lead efforts to streamline operations, reduce costs, and improve patient outcomes. You will lead initiatives to improve operational efficiency, quality, and profitability by analyzing processes, identifying areas for improvement, and implementing changes using data-driven approaches and best practices.

The Director will work cross functionally with internal and external stakeholders to build effective partnerships to enable improvement of processes, successful implementation of initiatives and ensure departmental success as measured by KPIs.

The Director will also ensure compliance with relevant regulations and standards related to UM and keep abreast of regulatory and industry changes.

Job Duties/Responsibilities:

1. Policy Management

a. Ensures compliance with relevant regulations and standards related to UM.

b. Writing clear and concise policies, guidelines, and rules for performing activities within the UM Department.

c. Evaluating different types of policies and making recommendations for changes regarding the policies to management.

d. Ensuring that revised and new policies are implemented.

2. Process Analysis and Improvement:

a. Analyze and document existing workflows and identify areas for improvement.

b. Develop and implement process improvement strategies.

c. Develops and implements UM strategies to ensure appropriate and efficient use of healthcare resources.

d. Document existing policies and processes and identify opportunities to enhance them or create new ones.

e. Lead the change management process and monitor changes to ensure success.

3. Data Analysis and Reporting:

a. Identify key performance indicators (KPIs) and track progress.

b. Use data to identify opportunities for improvement and measure the impact of changes.

c. Prepare reports and presentations to communicate findings and recommendations.

4. Leadership and Communication:

a. Provide guidance and advice to senior leaders and other stakeholders.

b. Communicate the benefits of process improvements to the organization.

c. Collaborates with various departments, including physicians, nurses, and other healthcare professionals, to promote effective UM practices

d. Participate in strategic planning and in the establishment of strategic directions and goals for clinical services operations. 

e. Manage and mentor team members, if applicable.

5. Continuous Improvement:

a. Stay up-to-date on industry trends and best practices.

b. Develop and implement a "best-in-class" continuous improvement strategy.

c. Innovate and implement new or revised models for the Organization's UM operations functions in response to evolving trends in healthcare delivery and/or emerging models of care.  

d. Build initiative roadmap for improvement with cross functional partners including DTS and operational resources

e. Conduct post-implementation reviews to ensure successful delivery and identify areas for further improvement.

Job Duties/Responsibilities:

Policy Management

Ensures compliance with relevant regulations and standards related to UM.

Writing clear and concise policies, guidelines, and rules for performing activities within the UM Department.

Evaluating different types of policies and making recommendations for changes regarding the policies to management.

Ensuring that revised and new policies are implemented.

Process Analysis and Improvement:

Analyze and document existing workflows and identify areas for improvement.

Develop and implement process improvement strategies.

Develops and implements UM strategies to ensure appropriate and efficient use of healthcare resources.

Document existing policies and processes and identify opportunities to enhance them or create new ones.

Lead the change management process and monitor changes to ensure success.

Data Analysis and Reporting:

Identify key performance indicators (KPIs) and track progress.

Use data to identify opportunities for improvement and measure the impact of changes.

Prepare reports and presentations to communicate findings and recommendations.

Leadership and Communication:

Provide guidance and advice to senior leaders and other stakeholders.

Communicate the benefits of process improvements to the organization.

Collaborates with various departments, including physicians, nurses, and other healthcare professionals, to promote effective UM practices

Participate in strategic planning and in the establishment of strategic directions and goals for clinical services operations. 

Manage and mentor team members, if applicable.

Continuous Improvement:

Stay up-to-date on industry trends and best practices.

Develop and implement a "best-in-class" continuous improvement strategy.

Innovate and implement new or revised models for the Organization's UM operations functions in response to evolving trends in healthcare delivery and/or emerging models of care.  

Build initiative roadmap for improvement with cross functional partners including DTS and operational resources

Conduct post-implementation reviews to ensure successful delivery and identify areas for further improvement.

Job Requirements:

Experience:

• Required:
  • Minimum 6 years of experience in process improvement, product roll out/launch, project management, implementation and operational performance management with at least 3 years in a leadership role.
  • 2-3 years of experience in clinical services and/or health plan care management functions
  • Experience in case management, utilization management, and population health with solid knowledge of best practices in all aspects of medical management  
• Preferred:
  • Healthcare or Insurance industry experience

Education:

• Required:
  • Bachelor's degree or four years additional experience in lieu of education.
• Preferred:
  • MBA or MHA

Specialized Skills:

• Required:

• Solid understanding of health plan operations and their impact on financial performance
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
• Mathematical Skills:  Ability to perform mathematical calculations and calculate simple statistics correctly
• Project & client management skills - ability to scope projects, create workable project plans, closely partner with key stakeholders, and execute on such plans while demonstrating an ability to balance multiple competing priorities
• Reasoning Skills:  Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
• Problem-Solving Skills:  Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Report Analysis Skills:  Comprehend and analyze statistical reports.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.  While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $113,332.00 - $169,999.00

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.

Salary : $113,332 - $169,999