Fallon Health Medical Management Program Manager in Worcester, Massachusetts

Overview

Brief summary of purpose :

Primary responsibilities include identification, evaluation, implementation and prioritization of medical management initiatives. These include the Cost of Care initiatives to manage company medical expense. Through the Cost Savings Committee, Cost of Care Committee, and other relevant committees, facilitates cost containment initiatives across all lines of business with significant attention to ROI. Responsibilities also include supporting senior medical management in promoting greater collaboration, synergies and integration across medical management teams. Responsibilities also include development and implementation of an enterprise-wide, in-house CME/CEU program. Ensures adherence to Program plans and schedules and develops solutions to program and project challenges. This position has a significant focus on the skill and diplomacy/tact required in working across functional areas and external organizations to ensure that the cost of care and other key initiatives are progressing as planned. These projects are multifunction and may be multiyear in scope.

Responsible to provide expert knowledge of development methodology approaches, techniques and tools to senior management, project managers, program teams and project teams.

Responsibilities

  • Supports the development, implementation, and measurement of cost of care programs initiatives.

  • Supports the development with business owners of opportunity analysis including coordinating with Medical Economics on actuarial evaluation.

  • Plans and manages monthly cost of care meetings. Facilitates planning sessions for annual initiative development and for prioritized initiatives

  • Prioritizes and supports allocation of available project and/or program resources to ensure goals and objectives of the cost of care initiatives are met and participates in analytical review of savings opportunities.

  • Develops and implements an enterprise-wide, in-house CME/CEU program.

  • Forms and leads a cross-departmental CME/CEU planning committee.

  • Oversees the appropriate accreditation and documentation required for securing CME/CEU credits.

  • Provides project management support to senior medical management in developing cross-departmental synergies, collaboration, and integration to eliminate inefficiencies and ensure optimal use of medical management resources across the organization.

  • Demonstrates influencing skills in managing team members, stakeholders and senior leadership.

  • Develops and maintains strong partnerships with management at all levels of one or more business units.

  • Provides timely and effective communication of project status and key milestones to all stakeholders.

  • Supports business owners in developing and tracking outcomes/success metrics and ensures accurate and timely reporting of key metrics, including, but not limited to, cost of care initiative metrics, staff productivity metrics, and more.

  • Facilitates the identification of best approach(s) across Payment Policy, Unit Cost, Utilization, or Benefits to achieve maximum Medical Cost reduction for prioritized cost drivers

  • Ensures adherence to Program plans and schedules and develops solutions to Program and project challenges.

  • Performs other duties as assigned.

Resources used in performing role:

  • Strong verbal and written communication skills

  • Build Relationships - Relates to people in an open, friendly, accepting manner; initiates and develops relationship with others as a key priority; treats others with respect; is approachable.

  • Presentation Skills - Effective in a variety of formal presentation settings: one-on-one, small and large groups, with peers, subordinates, and bosses; speaks effectively.

  • Works Efficiently - Allocates own time efficiently; handles multiple demands and competing priorities; eliminates inefficiencies; conducts effective meetings

Qualifications

Education:

Business Degree required preferably in Business Administration, MBA preferred; clinical background valuable but not required.

License/Certifications

PMP or Certified Lean Six Sigma highly desirable

Experience

Requires demonstrated skill in leading cross-functional teams. Required 5+ years of project management experience in the field or in a related area. Relies on extensive experience and judgment to plan and accomplish goals. Experience in analyzing and utilizing data to drive business decisions. At least 5 years’ experience in healthcare analysis and/or management. Proficient in Microsoft Windows based office applications to include, MS Project, Excel, Word, PowerPoint, Visio, and SharePoint.

Job ID 5451

# Positions 1

Category Medical Management