at WPS Health Solutions in Marion, Illinois, United States
Who We Are
is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than . Proud to be military and veteran ready.
Culture Drives Our Success
WPS' Performance-Based Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce-both current and future-to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.
From 2021 to 2023, WPS Health Solutions was recognized for several awards:
The Director, Clinical Programs will lead all of the clinical functions across the Commercial and Medicare business lines. This role is responsible for the overall strategy, operational performance, and outcomes of WPS's Clinical Programs, building an industry-leading suite of clinical services that advance our member's clinical experience, including improving outcomes while lowering the total cost of care, and increasing administrative efficiency and provider experience. In addition, the Director will lead the clinical and non-clinical teams, as well as vendor partners to develop, implement, and manage the clinical services offered by WPS.
In this role you will:
Design and deploy innovative and industry leading clinical programs for Commercial and Medicare lines of business to include clinical support and management before, during, and after service's are performed.
Ensure that our clinical programs position WPS to compete in the areas of Utilization and Case Management, Clinical Review, Provider Partnerships, and Ad-Hoc Clinical Initiatives or Programs for specific lines of business such as ASO.
Develop and oversee the Clinical Programs budgets, metrics/goals and performance reporting
Create organizational structure and talent to deliver Clinical Programs metrics and goals
Determine and implement tools to support the Clinical Program team and work
Ensure work is performed meeting all Quality and Accreditation standards, advance and create standards, policies, and procedures
Ensure accuracy and timeliness of output and deliverables for assigned functional areas. Implements and ensures compliance with corporate management policies, practices, and procedures
How do I know this opportunity is right for me? If you:
Thrive on driving sustainable business growth
You are a visionary leader who cultivates and inspires high-performing teams through insightful mentorship and engagement strategies
You communicate with confidence, clarity, and sound reasoning when discussing concerns, ideas, and suggestions with all levels of staff and management
What will I gain from this role?
An opportunity to partner and collaborate across the organization, with Senior Management, Quality, Sales/Account Mgmt, Actuary, Product, and Operations
An opportunity to have a significant impact within a thriving organization
Experience working in an Agile environment to help drive high-priority work
Experience working in an environment that serves our nation's military, veterans, Guard and Reserves, and Medicare beneficiaries
Working in a continuous performance feedback environment
5 or more years of experience leading clinical functions across the Commercial and Medicare business lines
Bachelor's Degree in related field or equivalent post high school and/or related work experience
Active license as an RN in the State of Wisconsin or a valid multi-state compact license.
Must maintain license after hired.
Experience working in a large organization supporting multiple lines of business.
Remote Work Requirements
High speed cable or fiber internet
Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at )
Please review for additional information
$150K - $200K
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.
We are a remote-first... For full info follow application link.
Wisconsin Physicians Service Insurance Corporation is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities employer.