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Description

Who We Are WPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than 75 years. Proud to be military and veteran-ready. Culture Drives Our Success WPS' Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce-both current and future-to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities. We are proud of the recognition we have received from local and national organizations regarding our culture and workplace: WPS Newsroom - Awards and Recognition Role Snapshot The Clinical Program Manager is responsible for identifying opportunities within the clinical organization to improve the operational and financial health of the organization. The project includes identifying best practices, identifying opportunities for cost savings, and assisting with network and benefit design. The leader is responsible for collecting and evaluating data and conducting a rigorous pressure testing process for new ideas, including the identification of areas of risk before developing and implementing programs In addition, this role will: Effectively communicate with internal stakeholders including clinical leadership, product, and sales to develop and implement programs to ensure milestones and key deliverables are completed on time Critical to the success of this role is the ability to secure stakeholder buy-in and develop communication plans for internal and external stakeholders' Work closely with the clinical team and leadership to drive timelines and plans for the design, development, and implementation of clinical initiatives. Develops, translates, and executes strategies or functional/operational objectives for Clinical Service Ownership of key clinical affordability projects. Utilize standard project plan templates incorporating Enterprise-wide affordability tools and road maps. Responsible for all status updates and reporting associated with these projects Investigate new opportunities for affordability tactics by reviewing data/current initiatives and research for potential consideration. Present and champion recommendations to leadership Create overall program/process frameworks based on information, input, data, and relevant subject matter expertise to identify best practices and opportunities for improvement Review, create, and/or maintain workflows as part of the client management and or projects Use a process-driven approach to identify the root cause and mitigate risks Drive optimizations of clinical processes to ensure clinical quality and keep cost at a minimum, using identified quality methodology Accountable for ensuring seamless implementation of initiatives that will impact clinical management Evaluate processes and outcomes against benchmarks and metrics and identify potential business impacts of the current state Identify opportunities to increase efficiencies or effectiveness and recommend program implementation or process changes Directs and leads interactions with partner teams such as Product, Network, and Sales to resolve highly complex or unusu l business problems that affect major functions or discipline How do I know this opportunity is right for me? If you: Enjoy working closely with the clinical team and leadership to drive timelines and plans for the design, development, and implementation of clinical initiatives. Have the ability to transform sensitive situations into teachable opportunities. Possess strength in defending your decision-making based on your clinical knowledge. Enjoy educating providers. Are technically strong on computers. Are self-motivated and work with a great degree of independence. Have strong verbal and written communication. What will I gain from this role? Enjoying a remote position with daytime hours, no on-call work, no travel, and holidays off Collaborating with a team of both clinicians and non-clinicians. Deepening your understanding of Medicare and how the program works. Learning about our Hyland OnBase tool which is our content management system used for viewing electronic records. Experience working in an environment that serves our Nation's military, veterans, Guard and Reserves, and Medicare beneficiaries. Working in a continuous performance feedback environment. Minimum Qualifications: Bachelor's Degree in related field or equivalent post high school and/or related work experience 2 or more years of related work experience Experience using a process-driven approach to problem-solving (e.g., DMAIC method, Six Sigma, Paredo charts). Proficient with Microsoft Office 365 including Outlook, PowerPoint, Excel, Word, SharePoint teams Exceptional relationship skills with a proven ability to quickly build and maintain solid relationships across diverse functions and leaders. Executive-level verbal and written communication skills applied to external audiences as well as internal audiences Proficiency in analyzing and interpreting medical and financial data, with