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Develops and implements self-insurance coverages for businesses and organizations, utilizing knowledge of tax and insurance strategies, securities, insurance, pension plans, and real estate. Typically reports to Chief Financial Officer or Chief Operations Officer and supervises Insurance Director.: Understands organization's assets, liabilities, cash flow, insurance coverage, tax status, and financial objectives. Analyzes organization's financial status, develops financial plan based on analysis of data. Manages those, including brokers and consultants, who prepare and submit documents to implement coverages selected.

Management Services Organization Executive

Directs the overall operation and provides executive leadership in a management services organization.: Responsible for the profitability of a management services organization that manages business operations such as human resources, materials management, employee health and safety and financial management to improve productivity, lower costs, and enhance revenue. Establishes strategic plans and guides implementation. Confers with executive management to plan operational objectives, to develop policies and procedures, to coordinate functions and operations between divisions, departments and satellite locations, and to establish responsibilities and procedures for attaining objectives. Reviews activity reports and financial statements to determine progress and status in attaining objectives and revises objectives and plans in accordance with current conditions. Directs and coordinates formulation of financial programs and guides changes needed to reach financial goals. Represents the organization to major external authorities and constituencies. Plans and develops labor, and public relations policies designed to improve relations with patients, providers, employees, and the general public. Selects and evaluates performance of executive staff for compliance with established policies and objectives and contributions in attaining objectives. An advanced degree in a field of health or business is typically required for this position.

Total Quality Management TQI Executive

Provides executive leadership over the hospital’s quality improvement process and programs.: This is not a quality assurance position. Directs the development and implementation of programs and processes related to quality management and performance improvement. Directs and controls quality systems for clinical laboratories. Develops policies and procedures, monitors performance, and develops/reviews metrics for areas of responsibility. Identifies, analyzes, designs, measures, and continuously improves business processes that cut across functional boundaries. Assesses and prioritizes risk, conducts mock inspections, and reports results to senior management. May establish quality improvement project teams. Provides training and guidance to staff to ensure understanding and that quality, accreditation, and performance improvement are actively pursued. Implements processes and methodologies for the identification and sharing of best practices. Develops strategic initiatives and transforms initiatives into action plans. Develops and fosters effective collaboration between departments and other affiliated services to ensure an integrated approach to quality management. Facilitates and coordinates the redesign of processes and systems for improvement with a central focus on patient centered care and services, customer satisfaction, safety, resource efficiency, quality, and employee satisfaction. Develops new strategies to improve overall performance. Hires, develops and motivates a qualified quality management staff. An advanced degree in health care administration is commonly required for this position. The position requires strong clinical and quality management knowledge.

Client Management Director

Directs the activities of Account Executives in building strong relationships with clients. Plans, organizes, implements, and evaluates outcomes of the department's strategic plans. Typically requires a college degree in marketing and experience in the health care industry and previous supervisory experience.: Develops strategic initiatives and transforms initiatives into action plans. Works with Account Executives to service custom client groups. Assists in the development and management of strategic accounts. Oversees preparation, coordination, and delivery of plan performance presentations. Identifies supporting strategies for product and program pricing, retention, and net revenue growth. Prepares and manages the departmental budget. Hires, develops, and motivates a qualified Account Executive staff and assesses employee ability to achieve desired performance levels.

Medical Management Director

Develops and implements a comprehensive and diversified marketing program related to systems and Medicare services. Directs the identification and evaluation of special studies relative to the development of new services and programs. Typically requires a college degree with four years of health service marketing experience. : Oversees and coordinates activities necessary to build and maintain strong, strategic relationships by proactively identifying and meeting service delivery needs. Conducts demographic and other marketing studies to identify trends to maximize effectiveness of marketing efforts. Researches targeted markets and evaluates marketing strategies to identify potential consumers of services. Recommends appropriate policies regarding pricing, promotion, product, and market evaluations and marketing plans. Prepares reports and analyses showing progress or adverse trends and presents appropriate recommendations or conclusions to management. Oversees hiring, developing, and managing a qualified staff concerned with Medicare marketing services and managing accounts. May assist in various special project such as cost feasibility studies for proposed or ongoing programs.

Quality Management Director

Directs and manages quality improvement, preventive health, and related departments of the health plan to identify levels and changes in the quality of medical care. Establishes protocols and serves as a resource regarding accreditation standards and continuous quality improvement principles. Designs, develops, and implements quality improvement initiatives necessary for attaining NCQA accreditation. Typically required to be a graduate of an accredited School of Nursing or a Registered Health Information Administrator (RHIA) with a minimum of four years of experience in direct patient care or in administration of health programs.: Develops and implements educational programs for practitioners and enrollees relative to quality improvement, preventive health, early and periodic screening, diagnosis and treatment, and credentialing. Assists in the development of clinical practice guidelines for use by providers. Oversees hiring, developing, and managing a qualified staff concerned with the evaluation of the quality of member care. Implements the organization's policies on quality standards. May work in conjunction with the Medical Director to assess opportunities for improvement and implement changes that will have a positive impact on medical outcomes and compliance with the plan's policies and contractual objections. Prepares and manages the departmental budget.

Management Engineering Director

Facilitates improvements in operating performance and competitive positioning in a health care environment through fundamental rethinking and redesign of core processes. Serves as primary link to the process improvement teams and natural working groups and implementation teams. Enables key stakeholders' participation and acceptance of change efforts. Directs a variety of management engineering projects and programs to provide management with statistical data in areas including information flow, cost containment, work standards, staffing levels, and productivity. Recommends procedure level standards for time and materials to be used by the Cost and Financial Management Systems staff and Hospital Departmental Managers.: Develops and implements studies of hospital functions and systems to include data collections and flow-charting. Prepares narrative and graphic displays of the studies' findings. Develops and directs varied feasibility studies related to the implementation of new ancillary procedures, clinic studies, and hospital processes from a cost and effectiveness standpoint. Develops and initiates a plan to educate departments on various topics related to productivity management and improvement strategies. Provides assistance to the Internal Audit Department in operational review of hospital departments. Researches and analyzes trends. Coordinates the preparation of reports setting forth progress, adverse trends, and appropriate recommendations or conclusions. Determines fiscal requirements and prepares budgetary recommendations. Directs various personnel functions including, but not limited to, hiring, training, promotion, transfer, and schedules.

Case Management Manager

Oversees utilization management, care coordination, and discharge planning for patients. Assesses, plans, implements, monitors, and evaluates the services and options available to meet individuals' health needs, using screening criteria, developed critical pathways, and available resources to promote quality cost effective care outcomes. Supports the physician and interdisciplinary team in facilitating patient care in order to enhance the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. Identifies areas where performance improvement is needed, such as daily workflow, education, process improvements, and patient satisfaction.: Contributes to profitability and growth through expansion activities in case management (CM) care management. Assists in the development strategy with implementation of strategic, high quality, CM care management customer-specific products. Assists in the development of short- and long-term case management strategies, objectives, and budgets. Serves as resource for other departments in solving problems relating to patients, physicians, providers, payers, vendors, and accounts. Assists in development of and implements departmental and company policies and procedures. Conducts analysis of quality and productivity auditing of staff and departmental workflows. Directly manages licensed staff in CM Department, including interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; and addressing complaints and resolving problems. Assists the Director in the development and management of the CM Department budget, including monitoring overtime and associated costs, submitting purchase orders for departmental supplies, recommending additional staff, and assisting with purchases and capital expenditures requiring higher level authorization.

Health Information Management Head

Plans, directs and coordinates health information management activities that involve obtaining, summarizing, storing, and retrieval of permanent patient medical records.: Coordinates and implements health information management programs to ensure compliance with various accreditation and regulatory agencies. Monitors and ensures compliance with HIPAA guidelines. Prepares and manages the departmental budget. Hires, develops and motivates a qualified Health Information Management staff. Plans and implements policies and procedures for the Health Information Management department and supervises employees who analyze, compile, code, index and store permanent medical records of patients. Reviews medical records for completeness and accuracy, and assigns diagnostic and procedure codes. Develops new strategies to enhance service and improve overall performance. This position typically requires a Bachelor's degree in Health Information Management, certification as a Registered Records Administrator (RRA) and five years of Health Information Management experience.

Risk Management Manager

Plans, manages, and coordinates risk and insurance programs of establishment to control risks and losses. Identifies, evaluates, and implements corrective action against risks that may result in injury, property loss, damage, or legal liability. Analyzes and classifies risks as to frequency and potential severity, and measures financial impact of risk on company. Typically reports to director level and may have supervisors reporting to this position.: Selects appropriate technique to minimize loss, such as avoidance (reducing chance of loss to zero), loss prevention and reduction (reducing frequency and severity of loss), retention (including self-insurance and planned noninsurance), grouping of exposure units (to increase predictability of loss), and transfer (placement of property, activity, or risk with other establishment or insurers). Directs insurance negotiations, selects insurance brokers and carriers, and places insurance. Appoints claims and self-insurance administrators, and allocates program costs. Prepares operational and risk reports for management analysis. Manages insurance programs, such as fidelity, surety, liability, property, group life, medical, pension plans, and workers' compensation. Prepares operational and risk reports for management analysis. May direct loss prevention and safety programs. May select and direct activities of safety, engineering, and loss prevention experts. May negotiate with unions for employee benefits.

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