Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Director, Enterprise Quality Management Member Engagement Services

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Director and Equivalent
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190JX Requisition #
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Direct the strategies, day-to-day progress, activities, and outcomes of member engagement across all product lines and books of business, including the management of communication (targeted letters, newsletters and social media posts) to members throughout New York, Connecticut and all areas we serve.  Create and delineate Operations Plan Improvements throughout the company, based on a thorough investigation of data by each business segment to gain understanding of all member profiles and demographics in the regions where we operate.  Initiate and lead strategies for member engagement, by providing meaningful information to members that builds a connection from service providers to members centered around the value EmblemHealth provides at all points of contact.  Develop corporate-wide initiatives at EmblemHealth and Connecticare to raise STAR ratings, strengthen our CAHPS scores and Medicaid QIA ratings, by leading other departments to make meaningful changes in current practices and methodologies that improve the ways members experience Quality in the services provided.  Manage communication and contact with members, including making members feel welcome, helping new members acclimate, building a solid foundation of information accessible to members to answer questions, informing and engaging them at each point of service delivery based on partnerships throughout the company rooted in a commitment to Operational Excellence.  Manage the teams who conduct Host Outbound Survey calls and Quality Health Navigator calls.  Apply Change Leadership to influence effective business decisions and outcomes.

Responsibilities:
  • Lead initiatives designed to drive improvements in the Medicare Stars rating and Medicaid QA across the enterprise, improving core process efficiency, effectiveness and responsiveness with staff in multiple locations based on member-specific needs by geographic location and demographics. 
  • Measure and improve business critical operational KPIs/metrics, especially in the areas of customer satisfaction/loyalty/retention.
  • Direct, align, and cascade operations planning across the enterprise with corporate business goals to improve member engagement across demographic of each line of business using telemonitoring initiatives, ongoing communications, and personalized social media outreach. 
  • Partner with senior and line management to facilitate implementation of recommendations. 
  • Define and evaluate targeted member surveys, producing a data-driven approach to membership engagement.
  • Develop and present a clear understanding of membership within industry trends; support building engagement and service satisfaction patient-by-patient, with a goal of personalizing communication to members to the extent possible.
  • Establish engagement goals for members and patients and define results in measurable numbers (i.e., blog comments, portal user and participation rates, sharing content with others on social media, etc.). 
  • Evaluate current engagement rates with goals to improve them and working with senior leadership, design a program and methods of communication to solve identified problems on an ongoing basis.
  • Create events, communications and efficient ways to connect with members (such as single sign-on options) that make it easy to participate in the company’s tools and resources. 
  • Lead corporate-wide Communications initiatives that account for findings in data about members’ experiences, addresses concerns and answers their questions, and presents Quality initiatives designed to serve them.
  • Direct the program and corresponding technology, digital tools and infrastructure needed for EmblemHealth to communicate with members in the most personal and effective ways across the channels that members prefer – (i.e., direct mail, email, social media, mobile or video) to improve member satisfaction, and optimize member experience.
  • Anticipate, identify, and produce written communications to members that address concerns and issues. 
  • Provide analytical expertise and recommendations to senior management for identifying, planning, and implementing a Member Incentive Plan from point of onboarding. 
  • Align Quality Health Navigator Team objectives and projects with data-driven priorities across the enterprise.
  • Manage/Oversee/Develop Quality Health Navigator Team.
  • Manage Stars Team in all locations, providing guidance and career development opportunities.
  • Manage cross-functional project team(s) directly or via matrix in each office we operate; provide individual contribution using Business Process Management, Lean and Lean Six Sigma tools and techniques to improve quality Develop metrics, processes and procedures that drive Operational Excellence and Consumer Value.
Qualifications:
  • Bachelor’s degree in Business, Healthcare, or related; Master’s degree preferred.
  • Lean Six Sigma Black Belt or Lean Master certification preferred.
  • 10 – 12 years related work experience, in positions of increasing accountability and complexity required
  • 5 – 8 years of managerial experience with teams in several locations, with demonstrated ability to work in a matrix management environment required
  • Travel to offices in New York and Connecticut and across the enterprise required
  • Account management experience required
  • Knowledge of project management practices. Experience in the development and implementation of managed care financial, business, policy or service initiatives required
  • Experience in production and/or performance standard development, and measurement mechanisms required
  • Proven experience in leading the implementation of large scale (large division/enterprise level) projects or initiatives required
  • Team leadership experience required
  • Excellent organizational, communication and interpersonal skills, detail orientation and a self-starter required
  • Excellent critical thinking and problem-solving skills required
  • Ability to collaborate cross functionally and to challenge the status quo as required
  • Comfortable with analyzing data, identifying trends, calculating impact and synthesizing data into actionable information required
  • Proficient with Microsoft Office (word processing, database/spreadsheet, presentation) required
  • Comprehensive knowledge of Medicare programs including regulatory and compliance as well as operations (e.g., customer service, marketing and sales) required
  • Demonstrated experience leading transformational change programs from assessment to execution in process improvement/ re-engineering required
  • Working knowledge of Minitab, Lean, Business Process Management and Data Mining tools and techniques preferred

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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