Clinical Program Manager

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Clinical Program Manager provides support to health system provider partners as well as Medica's product and segment teams. The Clinical Program Manager will work collaboratively with leadership and cross-functional partners to design and develop actionable strategies to address health system specific clinical cost and utilization opportunities.

This position is responsible for supporting and maintaining the clinical relationship with Medica's provider partners, working to identify and implement clinical interventions to improve outcomes and quality of care, decrease unnecessary medical spend, and improve care efficiency. The incumbent works in close collaboration with Medica's clinical services, network management, and analytics departments.

This position requires understanding of managed care business practices, provider delivery governance, internal and external operations, design thinking, and the development and use of actionable analytics. Strong relationship management skills are critical for this role as is the ability to manage complex clinical projects using established project management tools and methodologies. Performs other duties as assigned.

Key Accountabilities

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  Identify and develop clinical interventions and services that positively impact medical trend and quality

  
  
  
  
  • Identify interventions that improve value of care for our members including improved quality and access to appropriate care, while sustaining appropriate decreases in unnecessary medical trends.
  • Provide insights and recommendations to care system clinical operation teams related to provider clinical operations, with the goal of improving performance in the quadruple aim.
    
    
    
    • Provider partnerships include ACOs (Accountable Care Organizations), TCOC (Total Cost of Care) partnerships, Medicare Advantage, and Medicaid programs
    
    
    
    
  • Use clinical and financial data analysis to support strategy, tactics, and communication of results to achieve an provider partner's performance KPIs (key performance indicators).
  • Perform and translate data analysis to highlight care system performance and provide insights into areas of impact and improvement throughout the organization.
    
    
    
    • Supports efforts to define and socialize Medica provider analytics strategies and implement analytic methods and tools in support of the strategies.
    
    
    
    
  
  
  
  
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  Engage providers in strategic collaborative activities

  
  
  
  
  • Engage care system population health leaders in strategies and tactics that improve quality and access to appropriate care, including identification of both member and system level opportunities.
  • Works with provider partners to identify transformational and innovative services that become the basis for value-based payments. Provide a forum for our partners to network and share best practices.
  • Influence and motivate provider partner's clinical teams identifying and implementing strategies to reduce variations in performance.
  • Project support across all stages includes planning, communication, implementation, and evaluation of performance of projects.
  
  
  
  
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  Support Overall Clinical Value Strategy

  
  
  
  
  • Supports defining and prioritizing business requirements for data requests, data validation, and clinical data analysis.
  • Establishes annual priorities, KPIs, and targets that align with and support clinical leadership and other business units.
  • Collaborates on annual team goals aligned with the priorities of clinical services, Medica and our provider partner care systems.
  • Serves as an effective leader and representative of Clinical Services on various Medica committees.
  • Fosters good communications with staff, customers and other company departments through interpersonal relationships and formal communication skills.
  
  
  
  

Required Qualifications

• Bachelor's degree in nursing, public health, healthcare administration or related clinical field
• 5+ years of equivalent work experience beyond degree

Preferred Qualifications

• Master's degree in nursing, public health, healthcare administration or related clinical field
• Strong proficiently in project management tools, including six sigma
• Comfortable presenting to executive level stakeholders
• Proficiency in MS office specifically MS Excel and PowerPoint
• Demonstrated ability to design, evaluate, and interpret complex clinical programs, with strong problem-solving skills
• Excellent written and verbal communication skills, capable of conveying complex information clearly and concisely to diverse audiences
• Experience working both independently and collaboratively in cross functional teams, engaging with individuals from diverse professional backgrounds

Skills and Abilities

• Understanding of clinical care structures/operations
• Program or Project Management experience
• Understanding of data, ability to tell the story
• Innovative, and critical thinker
• Demonstrated capability to present key findings effectively to a non-technical audience both written and verbal
• Experience working with claim/employer group data, including John Hopkins ACG Grouper, Milliman HCG Grouper
• Demonstrated problem solving skills
• An internal drive to understand root cause and an inherent curiosity to problem solve
• Ability to function in a fast-paced, dynamic culture is important for success in this role
• Strong proficiently in project management tools, including six sigma
• Comfortable presenting to executive level stakeholders
• Proficiency in MS office specifically MS Excel and PowerPoint
• Demonstrated ability to design, evaluate, and interpret complex clinical programs, with strong problem-solving skills.
• Excellent written and verbal communication skills, capable of conveying complex information clearly and concisely to diverse audiences.
• Experience working both independently and collaboratively in cross functional teams, engaging with individuals from diverse professional backgrounds.

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Omaha, NE or St. Louis, MO

The full salary grade for this position is $87,100 - $149,300. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $87,100 - $130,620. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.