Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Medical Cost Transformation Leader
- 💼
- EmblemHealth
- 📅
- 3 days ago Post Date
Summary of Position
Research, develop, recommend, implement, monitor, and report on strategies to create self-funded client value, bending the medical cost curve, and reducing administrative cost burdens. Lead the identification, business case development and implementation of high impact clinical initiatives. Inform and develop clinical strategies to achieve annual financial goals with executive stakeholder agreement. Monitor ROI for medical cost trend reduction programs.
Principal Accountabilities
- Establish the medical cost strategy for medium and high valued cost initiatives using in depth internal and external information to enable executive decision making.
- Lead the high valued initiatives from business case development and stakeholder agreement through stabilization and ongoing ROI monitoring phases cross functionally.
- Lead financial business case development for new high value initiatives along with ongoing performance assessment of current initiatives.
- Direct opportunity analyses aimed at driving strategic revenue targets, innovating in the clinical care space, supporting initiatives to lead process efficiencies, and to determine the best course of action for a medical cost reduction strategy.
- Support vendor assessments to determine the true value of a proposed solution.
- Lead projects to completion through effective process mapping and collaboration with financial projections and analysis.
- Develop clear, articulate, actionable business cases targeted towards executive audiences, post implementation stabilization monitoring strategy, ROI monitoring strategy.
- Prepare executive level materials for presentations to enterprise leaders and decision makers.
- Provide the clinical leadership team with definition of program-level strategy to achieve medical cost savings targets.
- Provide concept and tactical knowledge and support to the assigned implementation managers through implementation and organizational readiness.
- Ensure appropriate principles of change management are in use, along with performance metrics and dialogs/committees.
- Ensure that appropriate corrective actions plans are deployed, including monitoring/measuring effectiveness.
Qualifications
- Bachelor’s degree
- MBA / MHA preferred
- 10 – 12+ years of relevant, professional experience
- 8+ years’ experience in a managed healthcare environment
- Proven efficacy working in a highly matrixed environment to influence and drive decision making
- Management Consulting, and / or Clinical setting experience
- Ability to synthesize data and turn it into actionable insights, identifying patterns and trends, using these insights to drive specific, practical actions
- Vendor management experience and an ability to effectively evaluate, source and monitor vendors
- Ability to build and maintain relationships with staff up to and including leadership
- Excellent analytical, organizational, and problem-solving skills
- Proven track record of successfully managing multiple competing projects simultaneously
- Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.)
- Exceptional communication skills (verbal, written, presentation, interpersonal, negotiation, influencing/persuading)
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.