Job Information
WPS Health Solutions Clinical Program Management - Remote in Madison, Wisconsin
Description
Who We Are
WPS Health Solutions (https://www.wpshealthsolutions.com/about/index.shtml) 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 (https://www.wpshealthsolutions.com/75/) . 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 (https://www.wpshealthsolutions.com/news/?c=awards)
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 unusual 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 the ability to translate data into meaningful/actionable information
Proven strategic analytical skills. Demonstrated ability to prioritize and balance multiple priorities and projects Team player and solid ability to work with other teams across the WPS enterprise Demonstrated ability to work productively and proactively in a dynamic, fast-paced, and constantly changing environment End-to-end understanding of medical cost management.
Preferred Qualifications
3 or more years of project and/or program management experience: Identifying critical paths, tracking, driving partners and projects to deliver within the targets, managing escalations, executive and presentations/communications
Aptitude to assess, identify, and remediate business gaps
Demonstrated ability to execute flawlessly on operational deliverables, including developing action plans to accomplish goals and providing ongoing updates on progress
Operational end-to-end thinker: broad clinical, claims, data, network, product delivery modality knowledge
Demonstrated ability to lead change and innovation
Solid strategic analytical skills
Relationship management skills: internal (staff, matrixed resources) and an ability to influence without authority
Excellent conflict management skills
Remote Work Requirements
Wired (ethernet cable) internet connection from your router to your computer
High speed cable or fiber internet
Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
Please review Remote Worker FAQs (https://secure.wpsic.com/files/remote-work-faqs.pdf) for additional information
Salary Range
100K to 135K
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills and experience.
Work Schedule
Full-Time, Salaried
Monday through Friday with start times flexible
Work Location
We are a remote-first organization and offer remote work in the following approved states:Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin
Benefits
Remote work option available
Performance bonus and/or merit increase opportunities
401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)
Competitive paid time off
Health insurance, dental insurance, and telehealth services start DAY 1
Employee Resource Groups
Professional and Leadership Development Programs
Review additional benefits: ( https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml )
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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)