RN UM, Clinical Policy Program, Clinical Cons V

Job Summary:

Serves as lead consultant to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive successful initiatives and projects within clinical settings across one or more technical areas or work streams. Provides expertise and drives the development and implementation of clinical initiatives, systems, and/or processes to a desired future state. Develops clinical or care delivery strategy and ensures organizational alignment and prioritization of clinical initiatives by developing and determining goals and priorities with management team sponsors;

defining, developing, and evaluating performance metrics. Manages complex, highly visible projects or project components, leads change management activities, and performs or partners with analysts on complex data analyses to drive care delivery or clinical initiatives. Participates in vendor management as required. Monitors compliance of work activities by ensuring project plans and team members adhere to relevant policies and procedures.

Essential Responsibilities:

+ Promotes learning in others by communicating information and providing advice to drive projects forward; builds relationships with cross-functional stakeholders. Listens, responds to, seeks, and addresses performance feedback; provides actionable feedback to others, including upward feedback to leadership and mentors junior team members. Practices self-leadership; creates and executes plans to capitalize on strengths and improve opportunity areas; influences team members within assigned team or unit.

Adapts to competing demands and new responsibilities; adapts to and learns from change, challenges, and feedback. Models team collaboration within and across teams.

+ Conducts or oversees business-specific projects by applying deep expertise in subject area; promotes adherence to all procedures and policies. Partners internally and externally to make effective business decisions; determines and carries out processes and methodologies; solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Develops work plans to meet business priorities and deadlines; coordinates and delegates resources to accomplish organizational goals.

Recognizes and capitalizes on improvement opportunities; evaluates recommendations made; influences the completion of project tasks by others.

+ Serves as a lead consultant to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive successful initiatives and projects within care delivery or clinical settings across one or more technical areas or work streams by making significant contributions and/or providing leadership to high visibility projects to identify and resolve issues of strategic importance to the organization; identifying and ensuring representation and inclusion of appropriate stakeholders and team members;

building rapport and partnerships with stakeholder teams, third party vendors, and senior management to produce results that are outcome driven; working with stakeholders to set the strategic direction of initiatives, develop goals and set the prioritization of deliverables; discussing involvement of key processes (e.g. quality management, project change management, communication) and facilitating decisions necessary for the delivery of initiatives; communicating tough issues to stakeholders while maintaining an independent perspective;

providing expertise and recommendations; developing written materials for senior executives and other key clients; and making formal presentations and providing reports to various senior level audiences.

+ Develops requirements, or leads a team of consultants in the development of requirements, for complex or specialized clinical, process, or system solutions across one or more technical area(s) by partnering with stakeholders and cross-functional teams as appropriate; leveraging multiple requirements gathering methodologies to identify clinical, functional, and non-functional requirements; leading and overseeing the development and documentation of comprehensive case studies to assess the costs, benefits, and ROI of proposed solutions;

collaborating in the development of results-driven action plans; and leading team members in the development process as appropriate.

+ Provides expertise and drives the development and implementation of clinical initiatives, systems, and/or processes to a desired future state by maintaining a comprehensive understanding of how current processes impact clinical operations across multiple technical areas; mapping current state against future state processes; identifying the operational impact of requirements on upstream and downstream solution components; providing options and recommendations to senior management and clinical stakeholders on how to integrate solutions and deliverables with current systems and processes across regions or technical areas;

and identifying and validating value gaps and…