Director, Us Healthcare Jobs

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Reporting to the Vice President, Enterprise Benefits and Well-Being, the Director, US Healthcare will be responsible for healthcare purchasing and innovation, primarily focused on providing access to quality and affordable healthcare to the company’s U.S. workforce while controlling plan costs, improving health outcomes and promoting employee engagement through broad-based, state-of-the-art interventions. The Director will develop solutions encompassing: health plan network optimization, onsite medical/pharmacy and hospital systems vendor evaluation, management, negotiation, pricing and funding tactics.

Responsibilities:

• Negotiate and operate one of the largest direct hospital contracts in the U.S. with 50,000+ covered lives in Central Florida.
• Responsible for population health/disease management, identifying key areas to support and developing and deploying solutions to address the evolving needs of the population.
• Oversee CLW expansion through on-site/near site facilities, leveraging scale and vendor partnership.
• Oversee processes and make recommendations to improve efficiency and effectiveness of programs, design, and policies.
• Explore innovative approaches, including integration with benefit offerings in partnership with entire Enterprise Benefits team.
• Ensure the company’s current direct contracts, related approaches and future innovative network solutions best serves our employees, Cast Members, their families and the company with lower cost, higher quality options.
• Provide direction on the monitoring of claims of direct hospital contracts, implement cost saving tactics and oversee efficiency of operations.
• Lead relationship manager for on-site service partners responsible for the administration of the onsite medical, pharmacy, vision, women’s health, and medical fitness locations, including national virtual health solution. This includes the Centers for Living Well (CLW), one of the largest U.S. programs encompassing patient-centered primary care facilities.
• Design and execute on overall Women’s Health strategy.
• Evaluate and develop healthcare network optimization strategies in key regions nationwide, inclusive of COE strategy.
• Manage TPA vendor for direct hospital contracts and integration with hospital systems.
• Hold partners accountable for quality metrics, population health and lifting up community standards to address social determinants, while maintaining plans affordable for the company, employees, and their families.

In Partnership with Integrated Benefits Operations Team:

• Support management and operation of national healthcare vendors.
• Partner with project management and service delivery teams on implementation of new programs, while also providing a seamless experience to employees. This includes identifying gaps and inefficiencies and working together to resolve in an efficient manner.
• Stay up to date on regulatory and compliance as it pertains to healthcare, making sure the plans meet needed requirements.
• Integrate Central Florida direct hospital contracts with national healthcare vendors.

In Partnership with US Benefits Strategy and Well-Being

• Collaborate on strategic objectives and execution of physical well-being pillar.
• Partner on data and analytics review of healthcare metrics to drive strategy.
• Help establish plan design and plan offering changes.
• Incorporate network optimization and population health strategy into holistic well-being strategy.
• Strategize and develop new healthcare designs and innovative approaches to ensure the best outcomes for our Cast and the company as it pertains to union contracts.
• Work with national healthcare vendors on strategic initiatives in alignment with key priorities.

Requirements:

• Strong strategic and service orientation with ability to proactively understand needs and present/implement solutions
• Strong technical knowledge of self-funded/self-administered healthcare, employee benefits plan design, insurance products, current trends, and legal and regulatory environment
• Leadership presence and stakeholder management – ability to synthesize and articulate complex subject matter to senior leaders and key stakeholders
• Working knowledge of value-based purchasing and patient-centered primary care design
• Proven experience leading teams, managing multiple projects simultaneously and producing quality deliverables on time and within budget
• 10+ years of experience in healthcare consulting or client account management, with progressive leadership responsibilities – corporate Benefits experience a plus
• Experience leading and managing large/jumbo programs/clients
• Analytical and technical experience a must; medical/healthcare underwriting preferred
• Excellent negotiation acumen – strong verbal and written communication skills

Required Education:

• B. S. degree in Actuarial Science, Public Health, Healthcare Management, or related field