Manager, Clinical Services Business Insights chez Community Health Plan of Washington

Who we are

About the Role

Provides oversight of strategy, auditing, training, analytics, and reporting for the Clinical Services business unit. Responsible for daily oversight of monitoring programs, managing department projects and internal and external reporting of Clinical Services programs. Ensures Clinical Service programs and processes align with applicable regulatory standards including Centers for Medicare and Medicaid (CMS), Dual Eligible Special Needs Plans (DSNP) Model of Care (MOC), Health Care Authority (HCA), and National Commission for Quality Assurance (NCQA). 

To be successful in this role, you:

• A bachelor’s degree in a relevant field such as Public Health, Health Informatics, Business Administration, or a related discipline; a relevant master’s degree, such as MPH, MHA, MBA, or MS in Analytics is highly preferred.
• Have five (5)+ years of progressive experience in project management, program management, or healthcare analytics with at least three (3) years in a leadership or supervisory role, required.
• Have a minimum of three (3) years of working experience at a Managed Care Organization (MCO), required.
• Have experience managing large scale projects with both clinical and non-clinical stakeholders, required.
• Have experience as a strategic partner to clinical leadership, translating business needs into technical requirements and ensuring outputs are aligned with operational priorities.
• Professional certifications demonstrating expertise in project management, analytics, or process improvement preferred.

Essential functions and Roles and Responsibilities:

• Manages staff, including coaching direct reports for optimal performance.
• Responsible for divisional auditing and reporting to ensure compliance with department productivity metrics and regulatory requirements.
• Provides operational oversight and supervision of staff performing internal & external Auditing Process Oversight for Clinical Services
• Collaborate closely with clinical leaders to identify opportunities for intervention, monitor program performance, and evaluate program effectiveness and impact.
• Lead cross-functional analytics and reporting projects from initiation through execution, ensuring alignment with clinical operations goals across care management, utilization management, behavioral health, quality, and pharmacy. Leads the integration of contract changes to ensure they are fully implemented into Clinical Services programs and services.
• Manages the division onboarding process which includes delegating and supervising staff to ensure that all department staff are trained to department standards.
• Other Duties as Assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Knowledge, Skills, and Abilities:

• Ability to communicate insights clearly to both technical and non-technical stakeholders, tailoring messages to clinical, operational, and executive audiences.
• Ability to set performance expectations, coach for performance success, and achieve department and company objectives.
• Ability to plan, assign and/or delegate, and supervise the work of others.
• Knowledge of regulatory and certification requirements and their impact on the organization such as Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), and NCQA.
• Ability to leverage healthcare analytics to support clinical operations teams with actionable insights that improve member outcomes and operational efficiency.
• Well versed knowledge in tools such as SQL, Power BI/Tableau, and project management platforms (e.g., Jira, Smartsheet, or MS Project) to manage deliverables and communicate progress.
• Ability to organize, prioritize, and manage work to meet deadlines.
• Ability to work with attention to detail and accuracy.

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check.

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Exempt and is eligible for overtime. Based on market data, this position grade is 69 and has a 10% annual incentive target based on company, department, and individual performance goals.

CHPW offers the following benefits for Full and Part-time employees and their dependents: 

•  Medical, Prescription, Dental, and Vision
•  Telehealth app
•  Flexible Spending Accounts, Health Savings Accounts
•  Basic Life AD&D, Short and Long-Term Disability
•  Voluntary Life, Critical Care, and Long-Term Care Insurance
•  401(k) Retirement and generous employer match
•  Employee Assistance Program and Mental Fitness app
•  Financial Coaching, Identity Theft Protection
•  Time off including PTO accrual starting at 17 days per year.
•  40 hours Community Service volunteer time
•  10 standard holidays, 2 floating holidays
•  Compassion time off, jury duty

Sensory/Physical/Mental Requirements:

Sensory*:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

• Extended periods of sitting, computer use, talking and possibly standing
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
• Frequent torso/back static position; occasional stooping, bending, and twisting.

Mental:

• Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.