Medical Cost Management Senior Director - Remote

Join a Leading Healthcare Organization Making a Difference!

We are a prominent organization dedicated to enhancing the lives of over 190,000 workers and their families within the hospitality and gaming sector nationwide. Our commitment to innovation and excellence drives us to develop transformative programs and benefits that empower our participants to take charge of their health and healthcare. We invite you to consider this exciting opportunity as the Senior Director of Medical Cost Management, where you will play a critical role in shaping our medical cost management strategies.

Job Overview

As the Senior Director of Medical Cost Management, you will be responsible for designing and managing our Medical Cost Management plan. This involves spearheading initiatives to monitor medical and pharmacy cost trends and formulating action plans to capitalize on identified gaps or opportunities.

Key Responsibilities

• Develop and manage the Medical Cost Management plan, encompassing areas such as payment integrity, high-cost claims, complex bill review, high-cost member management, data integrity, and utilization management.
• Lead initiatives to monitor medical and pharmacy cost trends while identifying strategies for cost improvements across network and clinical programs.
• Formulate action plans to address identified opportunities, conducting research on industry standards and potential vendor solutions.
• Collaborate closely with Claims, Analytics, Underwriting, and Clinical teams to implement best practices for identifying and addressing medical cost drivers.
• Leverage historical data and competitive market insights to recommend benchmarks for assessing financial and operational performance (KPIs).
• Create metrics, reports, and models to facilitate effective monitoring and evaluation of network management, condition management, and unit cost improvement initiatives.
• Foster strong relationships across the organization with Executive VPs, Claims, Clinical Operations, Underwriting, and Analytics teams.
• Establish a cross-functional organizational and operational framework to achieve shared goals and objectives efficiently.
• Guide, mentor, and develop team members while ensuring effective staffing models are in place.
• Analyze challenges, develop alternative solutions, and implement recommendations for optimal outcomes.
• Oversee continued employee training requirements, safety protocols, and quality initiatives.
  
  

Required Skills

• Minimum of 10 years of relevant experience in healthcare finance, consulting, or network analytics.
• 5-7 years of experience in managing teams and leading initiatives.
• Strong capabilities in financial modeling and analysis, particularly in assessing ROI for decision-making.
• Proficient in business intelligence and statistical tools, with excellent reporting and presentation skills for senior leadership.
  
  

Qualifications

• A Bachelor’s degree in Finance, Statistics, Mathematics, Analytics, or a related discipline is required; a Master's degree is preferred.
• Candidates should expect to travel between 15% and 25%.
• Experience in managed care is a plus.
  
  

Career Growth Opportunities

We are committed to fostering a culture of professional growth and development. Our organization actively encourages employees to pursue advancement pathways, ensuring you have the resources and support to thrive in your career.

Compensation And Benefits

• Salary range: \(176,200 - \)229,100 (actual salary may vary based on experience and qualifications).
• Work Schedule: Remote role, Monday through Friday, totaling 37.5 hours per week, with 15% - 25% travel required.
  
  

Our Comprehensive Benefits Package Includes

• Medical, Dental, Vision coverage
• Paid Time-Off (PTO) and Paid Holidays
• 401(k) plan and Pension
• Short- and Long-term Disability
• Life Insurance and AD&D
• Flexible Spending Accounts (healthcare & dependent care)
• Commuter Transit support
• Tuition Assistance
• Employee Assistance Program (EAP)
  
  

Join us in leading the way in healthcare cost management and making a significant impact on the lives of our participants. We look forward to your application!

Employment Type: Full-Time