Job Description

Company :Highmark WholecareJob Description :JOB SUMMARYThis job plans manages and oversees the implementation of the strategic business and functional infrastructure continuous process improvement initiatives across multiple functional units and transformational support to include design throughout implementation to assure people/process/technical solutions align with strategic initiatives while driving consensus among business units. Designs activities including the documentation management and oversight of end to end workflow process analysis assuring improved productivity cost effectiveness appropriate embedding of key performance indicators and appropriate controls for both regulatory and compliance considerations.ESSENTIAL RESPONSIBILITIESPerform management responsibilities including but not limited to: involved in hiring and termination decisions coaching and development rewards and recognition performance management and staff productivity.Plan organize staff direct and control the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.Oversee the definition scoping chartering efforts for business process analysis/design projects related to process improvement initiatives assuring optimal business and functional delivery of the strategic delivery framework.Manages the business consultation services which include research analysis facilitation process modeling and business process improvement techniques to propose and implement business and system solutions that meet strategic objectives and compliance requirements.Establish and maintain strong working relationships across business unit/area level of management continuing to promote and continually broaden the level of business knowledge and the impact of quality/process improvement projects and programs.Oversee planning sessions with business owners to improve business processes and to prioritize and drive process re-engineering initiatives including process ownership and governance.Oversee the analytic processes data points and controls to determine sub-optimal performance communicate findings clearly and effectively and make recommendations for improvement. Identify root causes of problems and demonstrate the ability to development and make recommendations for solutions to mitigate root cause.Oversee the vendor management relationships with applicable business unit subcontractors assuring compliance with regulatory and accrediting entities and oversees the business unit compliance activities with regulatory and accrediting entitiesOther duties as assigned or requested.QUALIFICATIONSMinimumHigh School Diploma or GED5 years experience in either leading projects or designing and implementing operational processes to improvements to solve business challengesSubstitutionsNonePreferredBachelors DegreeSix Sigma Black or Green Certification3 years ofmanaged care and/or call center operations experience3 years of Medicaid/Medicare experience3 years of NCQA experienceSkillsThorough understanding of business operations requirements processes and business modeling concepts and demonstrated business knowledge required to evaluate corporate-wide implications of changes to products and programs to assess impact for all lines of businessSoftware skills including use of Microsoft Office software and other applicationsDemonstrated and highly proficient verbal communication skills to articulate ideas clearly to various audiencesTime management organizational and multi-tasking skills necessary to work in a fast-paced environmentTeamwork-focused/collaborative work styleSCOPE OF RESPONSIBILITYDoes this role supervise/manage other employees? YesWORK ENVIRONMENTIs Travel Required? YesDisclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties responsibilities and qualifications required of employees to do this job.Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on their race color age religion sex national origin sexual orientation/gender identity or any other category protected by applicable federal state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race color age religion sex national origin sexual orientation/gender identity protected veteran status or disability.EEO is The LawEqual Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated files/employers/poster screen reader optimized.pdf )We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process please contact number below.For accommodation requests please contact HR Services Online at HRServices@highmarkhealth.orgCalifornia Consumer Privacy Act Employees Contractors and Applicants NoticeReq ID: J215491