Easter Seals Jobs

SUMMARY: This position supports Emergient including WMAHP (IA, SD), NextBlue of ND (working with Arkos), and in VBA (and now working with Arkos), including participation in 3 governance meetings including Strategic Leadership Meetings, medical policy coordination, driving and influencing strategy with plan presidents and teams, and monitoring and reporting on progress to JV partners, BCBSM/EM executives, and multiple boards of directors. This position is also responsible for all aspects of clinical care delivery for the Emergient and is critical to the cost of care, Stars support, and Risk Adjustment support Emergient. Membership will double in size in January of 2025; membership is expected to continue to grow year over year. Additional responsibilities include: planning and execution for Emergient Clinical Value Initiative portfolio, with an emphasis on developing and maintaining multi-year planning and capabilities matrix to guide and inform capital planning process and annual budgeting. RESPONSIBILITIES/TASKS: * In collaboration with leadership and clinicians, develop the care delivery strategy for Emergient, adjusting as necessary * Coordinates medical policy committees * Manages vendor relationships * Responsible for reviewing data and analytics * Responsible for ensuring compliance with CMS final rules pertaining to Care Delivery * Serve as the clinical program consultant for AEP activities * Manage and assist in the development of a pipeline of opportunities with the purpose of achieving clinical value (Stars, Risk Adjustment and cost of care) for Emergient * Formalize plan for delivery of multi-year initiatives to achieve clinical value and medical cost savings. * Work closely with Finance, IT, and SHS Planning and Strategy functions to ensure efforts are aligned with overall Enterprise and Emerging Markets timelines. * Lead annual efforts to support Bid submission for Senior Health Services including, but not limited to: * Initiative / capabilities planning * Actuary cost savings certification * IT and Readiness estimation * Oversee the execution of projects to achieve clinical value and medical cost savings that have significant implications for Senior Health Services strategic plan and financial targets. These projects have significant visibility with Executive leadership and require position leadership to support the following type of activities: * Facilitate executive level discussions and comfortably engage executives to support strategic and tactical objectives of the business * Drive execution of program efforts and ensures strong alignment of work efforts * Manage issue escalation and resolution * Work cross functionally across the organization to drive delivery; spokesperson and representative for the business -- supports education of business objectives, drives structure, and works behind the scenes to get alignment, proactively anticipate issues, and foster communications across teams. DIRECTION EXERCISED: Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. EMPLOYMENT QUALIFICATIONS: EDUCATION: Bachelor's degree in a related field required. Master's degree in public health, health care administration or other related field is preferred. Valid Michigan Accident and Health Insurance License required. Valid and unrestricted driver's license required. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or