Medica Health Plans

Clinical Program Manager, Commercial Markets IV

Medica Health Plans$88K — $133K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's degree in Nursing, Public Health, or related clinical field; Master's degree or MBA preferred.
  • 7+ years of relevant work experience.
  • Clinical experience required.
  • Broad knowledge of managed care and healthcare industry.
  • Experience using Excel and BI tools like QlikSense and Power BI.
  • Strong analytical skills with experience in clinical utilization data.
  • Demonstrated leadership and project management skills.

Responsibilities

  • Review and analyze population performance data for employers.
  • Provide clinical insights and recommendations to internal and external stakeholders.
  • Support commercial accounts team with clinical reporting and analysis.
  • Facilitate adoption of personalized wellness programs for employers.
  • Create personalized wellness strategies leveraging available products.
  • Deliver professional presentations to current and prospective customers, including C-suite.
  • Participate in the development of clinical strategies for strategic accounts.

Benefits

  • Competitive medical, dental, and vision plans.
  • Generous paid time off and holidays.
  • Paid volunteer time off to support community engagement.
  • 401K contributions and retirement planning assistance.
  • Caregiver services to help balance work and personal responsibilities.
Full Job Description
The Clinical Program Manager-Commercial Market Division is a key contributor communicating clinical performance to commercial customers of Medica and helping to design solutions to meet the clinical and population health needs of our employer and broker customers. Strong relationship management skills are critical for this role as are strong presentation skills. This role operates in a highly matrixed environment, partnering with Commercial Sales & Retention, Commercial Product, Markets, and Enterprise Analytics.

Key Accountabilities

  • Review, analyze, and communicate population performance data for employers
    • Provide insights and clinical recommendations to both internal account team and external employer customers around clinical performance, performance trends, future trends/pipeline and wellness/clinical solution recommendations.
    • Analyze and present clinical data in partnership with commercial employer account team and enterprise analytics. Support market strategy through clinical and financial analytics. Ability to use self-service reporting.
    • Develop insights into clinical performance and opportunities for a given employee population.
    • Participate in development of clinical strategy for larger/more strategic accounts.

  • Support in Matrixed environment
    • Responsive support for commercial accounts team, providing clinical insights from reporting, including regular cadence of review and notification of new high-cost claimants.
    • Serve as a resource on commercial product options for the sales and account teams.
    • Understand local market business dynamics and incorporate these into analysis.

  • Facilitate adoption of personalized employer Wellness programs
    • Deep understanding of wellness and vendor programmatic options available to support employers, and also the specific details of selections and rationale for wellness options.
    • Consulting-like service including creating personalized wellness strategies for employers using the products available in our ecosystem.
    • Ambassadorship of commercial market strategy around product offerings and key strategies.

  • Presentations
    • Professional presentations to current and prospective customers (including C-suite) and their brokers.
    • Include RFPs/ finalist presentations in addition to periodic performance data.
    • Align with Medica's approaches to presenting data and clinical analytics approach.


Required Qualifications

  • Bachelor's degree in Nursing, Public Health or related clinical field; Master's degree or MBA helpful preferred.
  • 7+ years of relevant work experience.


Preferred Qualifications

  • Clinical experience required.
  • Broad knowledge of managed care, the healthcare industry and health plan care management functions; knowledge of state/federal health insurance regulations beneficial, however not required.
  • Experience and skill in using Excel, and other BI tools like QlikSense and Power BI.
  • Experience in building and delivering effective presentations.
  • Strong analytical skills.
  • Experience reviewing clinical utilization and performance data for potential opportunities.
  • Develop and maintain knowledge of market dynamics and business strategies.
  • Demonstrated experience delivering results in an ambiguous and changing environment.
  • Demonstrated success with project management, leadership, and implementation.
  • Creative problem-solving skills, adaptability, and strong communication skills.


This position is an Office role, which requires an employee to work onsite at our Madison, WI office, on average, 3 days per week.

The full salary grade for this position is $88,800 - $152,300. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $88,800 - $133,245. 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.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

About Medica Health Plans

Medica Health Plans is a non-profit health insurance company based in Minnesota. It was founded in 1975 and provides health insurance to individuals, families, and employers in Minnesota, North Dakota, South Dakota, and Wisconsin. Medica offers a variety of health plans, including HMO, POS, PPO, and Medicare Advantage plans. The company also offers dental, vision, and pharmacy benefits. Medica has received high ratings for customer satisfaction and quality of care. The company is committed to improving the health of its members and the communities it serves.
Learn more about Medica Health Plans
Size
1,700 employees
Industry
Founded
1975

Similar Jobs

More Jobs at Medica Health Plans

More Healthcare Jobs

Find similar Clinical Program Manager, Commercial Markets IV jobs: