Delivery Director Salary in Renton, WA

Vice President Clinical Service - Utilization Management & AppealsOregon, Washington, Idaho, UtahPrimary Job PurposeThe Vice President Clinical Services is a member of the Health Services Organization (HSO) leadership team focused on enabling members to achieve their best health by simplifying their care journey, improving quality, supporting providers in their delivery of care, and managing total cost. The VP of Clinical Services is accountable for clinical functions which may include care management, transition of care services, medical policy development and implementation, utilization management, facility stay reviews and appeals. This role helps shape and drive strategy and execution in support of integrated business solutions aligned to the needs of each health plan line of business (e.g. Medicare, individual, ASO, etc.). The position oversees internal programs and external vendors and plays a key role in medical cost stewardship and ensuring clinical quality of services to members.General Functions and OutcomesProvides leadership in developing, implementing, and communicating short and long-range plans, goals and objectives for the function.Aligns team goals with the organization's vision and strategy.Develops strategies and tactics to effectively manage healthcare costs and improve clinical quality across all product lines.Partners with leaders and stakeholders across the enterprise to prioritize activity and solutions in support of medical management strategies and operational plans.Develops, recommends, and implements clinical and operational policies and procedures.Develops and manages performance against business, financial, utilization, and operational metrics to ensure results are achieved across clinical services functions and various Lines of Business.Analyzes and uses information and data to guide the development and implementation of new or enhanced health care interventions that improve value to the member and payers.Ensures programs meet federal and state regulations, accreditation standards, quality metrics, client requirements and evolving models of care (e.g. accountable care organizations, patient centered homes).Determines appropriate staffing levels and resource needs, creates and manages department and/or project budgets, allocates resources and approves expenditures.Fosters an effective work environment and ensures employees receive appropriate communication, recognition, and professional development.Participates in organizational talent management and succession planning. Minimum RequirementsExpertise related to health insurance industry trends, evolving accountable care and payment models, case and utilization management programs and how to best partner with providers to achieve desired outcomes.Strong communication and facilitation skills with all levels of the organization, including the ability to resolve issues and build consensus among groups of diverse internal/external stakeholders.Strong leadership, negotiation and relationship building skills.Deep business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making.Demonstrated competency related to creating and executing business strategies and driving results within a large, complex organization and/or with external partners.Proven ability to implement and execute successful business transformation and lead through change.Proven ability to develop a high performing team and manage and develop leaders.The Vice President Clinical Services would have a bachelor's degree in business management, health administration or a related field, 10 years of management/leadership experience and five years of experience as a director for a health plan with responsibility for medical cost and quality management, with experience in delivering health care insurance programs or an equivalent combination of education and experienceFTEs Supervised4-6 direct reports and oversees a staff > 200.Work EnvironmentDuties are performed primarily in an office environment. Travel to other TRG affiliate plans and to regional offices may be required.The expected hiring range for a Vice President Clinical Service - Utilization Management & Appeals is $283,100-382,950 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 30% . The current full salary range for this role is $266,000-433,000. Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:medical, dental, and vision coverage for employees and their eligible family membersannual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)paid time off varying by role and tenure in addition to 10 company holidaysup to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)one-time furniture and equipment allowance for employees working from homeup to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

Senior Medical DirectorWashington - includes in state and out of state travelSingle large employer focus Primary Job PurposeSenior Medical Director provides clinical leadership and support to clinical teams to ensure HCA members receive quality, cost effective care yielding optimal outcomes, supports HCA's Health Technology Assessment program, the Prescription Drug Program, the Bree Collaborative, HEDIS and CAHPs performance and quality program, and other the HCA-identified performance improvement efforts as they relate to the UMP Plans and the State's health care purchasing system. This will include HCA customized medical policies and medical benefit design, WA state legislative mandates, clinical escalation support, participation in development of and organizational alignment to Bree Collaborative best practice recommendations, participation in development of care transformation strategic initiatives, and other requests from HCA. General Functions and OutcomesProvides clinical leadership for staff to ensure members receive safe, effective and cost efficient services.Contributes to the development of various medical management strategies and tactics to drive results and achieve key performance metrics.Conducts peer clinical review for medical necessity on utilization management authorization requests.Provides clinical input on case management reviews working closely with the CM clinical staff.Responsible for discussing review determinations with providers who request peer-to-peer conversations.Participates on multiple teams to provide clinical input on medical policy reviews and development and may participate on committees that develop programs impacting clinical interventions, utilization management and case management.Analyzes and uses data to guide the development and implementation of health care interventions that improve value to the member and employer.Advises Health Care Services Leaders on related key performance metrics and the effectiveness of various efforts, initiatives, policies and procedures.Identifies and communicates new opportunities in utilization management, provider contracting or other areas that would enhance outcomes and the reputation of the organization.Provides clinical expertise and coordinates between internal clinical programs and providers of care to improve the quality and cost of care delivered to health plan members.Ensures ethical decision making in compliance with contractual arrangements, regulations and legislation.Supports internal communication or training that ensures service is provided to members and providers by a well-trained staff.Promotes provider understanding of utilization management and quality improvement policies, procedures and standards.Provides guidance and oversight for clinical operational and clinical decision-making aspects of the program.Has periodic consultation with practitioners in the field and ensures that the organization has qualified clinicians accountable for decisions affecting consumers.May manage staff including hiring, performance management, development and retention.May participate in health plan credentialing operations and clinical aspects of the credentialing program and provider services support.Minimum RequirementsDemonstrated competency working with hospitals, provider groups or integrated delivery systems to effectively manage patient care to improve outcomes.Strong communication and facilitation skills with internal staff and external stakeholders, including the ability to resolve issues and seek optimal outcomes.Proven ability to develop and maintain positive working relationships with community and provider partners.Knowledge of the health insurance industry, state and federal regulations, provider reimbursement methods and evolving accountable care and payment models.General business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making. Strong orientation to the application of data in managing health and quality.Proven ability to develop creative strategies to accomplish goals and objectives, plan and execute complex projects and programs and drive results across internal teams and/or external partners.Demonstrated ability to effectively lead and engage in a constructive manner with others.Normally to be proficient in the competencies listed aboveSenior Medical Director would have a MD or DO degree, at least 5 years clinical experience, plus at least 2 years medical utilization management and/or case management experience (prefer health insurance experience and additional MHA or MBA training), or an equivalent combination of education and experience.Required Licenses, Certifications, Registration, Etc.Licensed Physician with an MD or DO degree. Active, unrestricted license to practice medicine in one or more states or territories of the United States. Board Certification required. Qualification by training and experience to render clinical opinions about medical conditions, procedures and treatments under review. #LI-RemoteThe expected hiring range for a Senior Medical Direct is $229,000 - $310,000 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 30%. The current full salary range for this role is $215,500 - $350,500. Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:medical, dental, and vision coverage for employees and their eligible family membersannual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)paid time off varying by role and tenure in addition to 10 company holidaysup to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)one-time furniture and equipment allowance for employees working from homeup to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

Manager Clinical Operational ExcellenceRemote in ID, OR, WA, UTPrimary Job PurposeResponsible for providing oversight and leadership for Cambia's Clinical Operational Excellence program to improve member health, operational excellence, and affordability. This position will provide: direct consultation on complex, cross-functional projects, oversight to the Clinical Operational Excellence team, and mentorship to health services managers/directors. The leader will develop the Clinical Operational Excellence program to help identify, prioritize, design, implement, and facilitate change management clinical operational excellence initiatives. General Functions and OutcomesHandles all management level responsibilities for staff, including performance reviews, employee development, hiring, firing, coaching, counseling, and retention.Assigns and prioritizes work, sets goals, and coordinates daily activities of the team. Provides regular updates and communication to staff through 1:1 and team meetings.Manages and provides oversight and leadership in the planning and implementation of process improvement initiatives. Accountable for the team's performance and results of cross functional process improvement projects. Directs and organizes overall effort to create new cross-functional capabilities.Provides leadership in developing, and implementing new processes that improve core operation, employer experience, consumer experience and/or project delivery.Seeks out information from customers and third-party stakeholders; uses it to establish prioritized operational solutions that drive ongoing enhancementsAdvises leadership and business executives about the improvement initiative portfolio status and resource planning for delivering strategic business initiatives.Consults directly at the executive level across the organization and executes process improvement initiatives on their behalf.Leads efforts to systematically collect, synthesize and report operational performance information, designs, implements and manages metrics and indicators to track performance to goals and objectives. Creates influential metrics, dashboards, and presentations that use information to influence senior leadership on business trends and strategies. Identifies, mitigates and manages operational risks and issues.Manages financial targets and department budget, authorizes expenditures, monitors workforce allocation and resources, and oversees project plans. In conjunction with division leadership, establishes and communicates long-term goals for the department and adapts operational plans as changes occur.Minimum RequirementsProven leadership competencies in recognizing process deficiencies, analyzing developing, implementing and measuring effectiveness of existing business processes, including process redesign and optimization with the ability to develop sustainable, repeatable and quantifiable improvement. Drives tangible and measurable improvements of key processes through the leadership, training, and mentoring of a team of change agents.Demonstrated ability in leading multiple, complex organizational transformation projects. Demonstrated adaptive leadership skill, leading teams through ambiguity and change in order to deliver complex strategic initiatives.Ability to develop and lead a team including: hiring, goal setting, coaching and development (including employees who may be in multiple locations or work remotely).Demonstrated analytical, influential and problem-solving skills, ability to analyze data and complex business situations, learn quickly and synthesize corresponding solutions, options and action plans.Familiarity with health insurance industry trends, operations and technology.Strong communication and facilitation skills with all levels of the organization, including the ability to resolve complex issues and build consensus among groups of diverse stakeholders.Normally to be proficient in the competencies listed aboveManager Clinical Operational Excellence would have a Bachelor's degree in Business, Engineering, Finance, or related field and ten years of experience in Healthcare process improvement, performance improvement business consulting, or general management with experience leading, developing and managing process improvement initiatives or a similar position or equivalent combination of education and experience. MBA is preferable but not required.Required Licenses, Certifications, Registration, Etc.Lean/Six Sigma Black Belt, Business Process Management (BPM/CBPP), or equivalent is required. Certifications in one or more of the following preferred: Change Management or Project/Program Management (PMP/PGMP)FTEs Supervised2-5Work EnvironmentWork primarily remoteTravel may be required, either local or out of state.May be required to work outside normal working hours.#LI-RemoteThe expected hiring range for a Manager Clinical Operational Excellence is $129,500 - $175,500 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 15%. The current full salary range for this role is $122,000 - $198,500. Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:medical, dental, and vision coverage for employees and their eligible family membersannual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)paid time off varying by role and tenure in addition to 10 company holidaysup to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)one-time furniture and equipment allowance for employees working from homeup to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

AD SALES OPERATIONS (HEALTHCARE)Telecommute option - Must reside in ID, OR, UT or WAWHO WE NEEDOversees all activities pertaining to the development, implementation and management of Sales Operations support across all four Regence markets. This management position is responsible for work with all levels of staff and management throughout Cambia, to clearly define strategies, plans, tactics and timelines for multidimensional operations and projects affecting Sales. Preferred Key Experience:Strategic business acumen including understanding of market dynamics, financial/budget management, data analysis and decision makingExperienced communication, presentation and facilitation skills with employer groups, brokers preferredNormally to be proficient in the competencies listed belowAssistant Director Sales Operations candidate would have:Bachelor's degree in business administration, health administration or equivalent field10 years of management experience in member operations, business services role, strategic projects Management experienceOr equivalent combination of education and experience.FTE's Supervised:Up to 100 multi location. (Front line thru manager)YOUR ROLE:Knowledge of practices, procedures, regulations & techniques as they relate to sales, sales operations, group implementation for all group lines of business quoting, new group onboarding, renewal, and mid-year maintenance.Comprehensive knowledge of the health insurance field, including sales processes, terminology, strategic development, cost analysis, and financial reportingDemonstrated ability to perform in-depth analysis; manage complex, multifaceted projects; manage processes across multiple organizational layers while communicating ideas and directions clearly and achieving desired results. Demonstrated ability to organize and manage back-office sales and operational functions. Thorough knowledge of the interrelationships between departments and systems within Cambia.Knowledge of health insurance industry operations, trends, and technologyGeneral business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making.Excellent writing, communication, and facilitation skills with all levels of the organization, including the ability to resolve issues and build consensus among groups of diverse stakeholders.Strong communication, presentation and facilitation skills with employer groups, brokers, and the ability to act as a sales advocate including the ability to resolve client and broker issues.Ability to identify issues, opportunities, and effective solutions and collaborate with other departments to improve processes and/or results.Ability to anticipate future trends accurately while maintaining broad knowledge and perspective on projects.Demonstrated expertise in strategic and tactical project planning and project management, including ability to develop and managed detailed project plans and timelines.Proven leadership skills with the ability to direct the activities of others on a direct or matrix team basis.WHAT YOU BRING:Provides oversight & direction to ensure timely and accurate delivery of group setup and enrollment transactional processing of small, mid, and large group onboarding and maintenance to include processing quotes, RFP's, implantation of all new groups, facilitation, tracking and processing of all renewing groups. This oversight includes end to end channel from quote to benefit documents and ID card generation.Ensures timely and accurate receipt of final paperwork for new and renewing groups, assignment of Group ID, member ID cards generation, facilitation of ordering and tracking of benefit document materials, SOC's, SBC's, SBS's, benefit booklets and group policy documents.Responsible for the activities performed by the Sales Operations department to assure onboarding performance goals are met including productivity, accuracy, timeliness and quality of service to our members and business partners.Provides direction, support and leadership for the Producer/Employer Service Center providing support to employer and brokers for small/mid-size groups. Strong technical skills in the production control, reporting development, requirements development for integration of seamless tools into health plan.Responsibility to direct and manage onboarding projects from visionary concept through final stages of development, implementation, and review.Facilitate the planning, development and implementation of key operational strategies and projects.Oversees project development and implementation activity including coordination with all internally affected departments and external partners, clients, or vendors.Ensure that all projects are in compliance with all applicable laws and regulations.Provides executive level onboarding reporting, monitors enrollment results, and analyzes the movement of membership to support corporate management decisions relating to product development, market strategy, broker incentives, and product- or segment-communications strategies.Provides direction for critical on-boarding functions which may include research, software training, enrollment forecasting, project management, analysis, systems, and budgeting.Provides performance reporting and training on Sales specific systems such as the proposal system or customer relationship management system. This includes sales & broker compensation programs.Coordinates with Strategic Communications, Product Development and outside vendors the testing, maintenance, and update functions of on-line applications for or all market communication tools and web sites.Works directly with Senior Executives to provide enrollment analysis or summary of project results which may include presentations in leadership meetings to present onboarding status reporting.The expected target hiring range for this position is $120k-$150k depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 15%. The current full salary range for AD Sales Ops is $112k Low / $141k MRP/ $184k High .Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:medical, dental, and vision coverage for employees and their eligible family membersannual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)paid time off varying by role and tenure in addition to 10 company holidaysup to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)one-time furniture and equipment allowance for employees working from homeup to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.