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Workstream Manager

Philadelphia, PA 19103

Post Date: 04/09/2018 Areas of Expertise: Technical Pay Rate: w2 rate only
  • Role: Workstream Manager
  • Industry: Healthcare
  • Location: Philadelphia, PA Zip: 19103
  • Interview Mode: Phone Screen followed by an onsite
  • Duration: 3-6 month contract to hire

This role is under Medical Management at my client.  This is where they determine utilization management, reimbursement policies (with doctors) and provider contracting.  This area is always looking for ways to reduce costs and they have  strategic goals in this area every year to reduce cost, while maintaining quality member care. This is a considered an area of high importance and these projects are vital to the longevity and profitability of the client.  

  • The MCT Workstream Manager will support ideation, investigation, business case development, implementation & stabilization phases of the E2E MCT process for MCT initiatives within assigned workstream. Support achievement of medical cost savings targets by conducting extensive industry and internal research as well as drawing on robust knowledge of managed care transactions & operations to identify & quantify medical cost transformation opportunities as well as internal & external impacts.                                                                 

Additional Responsibilities:

  • Conducts competitor analysis of medical cost transformation opportunities through extensive industry research of medical societies, national carriers and blue plans.                                                           
  • Facilitates workstream meetings and related ad-hoc forums designed to facilitate the investigation of identified opportunities; ensures action steps are clearly defined, accountable individuals are identified, timelines are established and follows up to ensure closure.                                      
  • Helps compile/develop the business intelligence necessary to fully define and articulate identified opportunities:
    • ensures necessary data is produced, analyzed and accurately interpreted
    • investigates IBC status quo, market precedent, degree of disruption (provider, member, other stakeholder)
    • supports assessment of alternative approaches to value capture and recommends approach
    • helps drive development of business cases - which include definition of the opportunity, the output of the investigation phase, recommended approach to value capture, ROI, internal/external impacts & impact management strategies -  to facilitate go/no go decision-making by MCT leadership, including senior executives
  • Provides SME support for implementation and post-implementation stabilization
  • Works collaboratively with business resources in key stakeholder areas (Provider, Clinical, CFID, Pharmacy, Service Ops, Marketing, Sales, IX, Finance, Actuary)   

Qualifications

  • Bachelor’s degree required; advanced degree preferred
  • Minimum of 5 years of relevant industry or functional work experience in health care management related field
  • Advanced Excel required 
  • Advanced claims research and analysis including provider, policy, and benefits expertise 
  • Strong problem solving and excellent communication skills, both written and verbal                                                                                         
  • Ability to develop and communicate clear business requirements, including requirements to support data requests.                                                       
  • Skilled in performing research, analysis and in providing fact-based insight for strategy development and planning; ability to summarize data output into meaningful insights and recommendations for executives and business leaders.  
  • Self-motivated, ability to succeed in ambiguous environment, and work under tight deadlines with rapidly changing priorities.
  • Enthusiasm for analytically intensive work 
  • Ability to work collaboratively in a team environment 
  • Ability to work effectively with people at all levels in an organization 
  • Confidence sharing your views and perspectives 

 

Caitlin Christ
Technical Recruiter

Caitlin has been recruiting for CSS Technical Services for over three years specializing in IT Staffing. She approaches every interaction as an opportunity to exceed our candidate’s expectations.
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