Director, Product Systems Innovation

Overview

Propose, design, & oversee implementation of technology solutions to deliver measurable operational and quality improvements to VNSNY CHOICE Health Plans in areas such as onboarding, member services, claims processing, new business processing, provider network management, etc.

Responsibilities

• Develop technology and healthcare data analytics solutions, such as reports and dashboards, to help senior management meet healthcare quality, compliance, & financial performance goals.
• Collaborate with leadership and sponsors in business units across Medicare and Medicaid product lines to deliver business transformation and strategic initiatives that optimize systems architecture, technology solutions and workflows, to enhance efficiency of managed care health plan business processes.
• Develop improved workflows and support systems to align goals of all health plans and improve Key Performance Indicators of each plan’s ability to deliver effective benefits to plan members.
• Gather business requirements from sponsoring unit; develop business case, project charter and project plan, including staff and budget; define scope, timeline and schedule for IT & operations process improvement projects of managed care health plan provider.
• Use mathematical and analytical methods to assess efficiency of health plan processes; investigate workflow, data management, and other complex operational issues.
• Use knowledge of business information systems, management principles, health plan reimbursement models, and applications of healthcare data analytics to develop proposed solutions and methods for strategic planning, and for budget, staff and resource allocation; and to propose and structure planned operational changes.
• Launch project implementation; manage cross-functional project teams, track progress and provide periodic reports to management. 4-6 direct reports, including data analysts and project managers.

Qualifications

Education: Master’s in MIS, IT Management or related field.

Experience:  Minimum 2 years experience as IT Project Lead/Project Manager on IT-driven process improvement projects & quality improvement projects for managed care plans, w/ health plan data reporting. Minimum 1 year of this experience must be w/ Medicare or Medicaid managed care plans. Minimum 1 year of this experience must be as lead on enterprise-level tech driven operations transformation projects for managed care plans. Requires successful delivery of at least 1 project working w/ CMS data universe & at least 1 project meeting National Committee on Quality Assurance standards.