SummaryExecutive level role

Job Description

POSITION SUMMARY: Preferred Health Care (PHC) is an managed care company that has developed and operated health plan solutions across central and eastern Pennsylvania since 1986.  Our core offering is Eliance Health Solutions, a self-funded health plan built by and powered by Penn Medicine.  Our approach provides full claims administration, medical management, network development/contracting, wellness, and insurance agency services.  

ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

Provide strategic direction and operational oversight including P&L management, financial control systems, budgeting, forecasting, and reporting.Develop and execute growth strategies to expand the group health TPA market share, revenue, and profitability, while maintaining high client satisfaction and retention.Lead, coach, and develop a high-performing team of managers and staff, ensuring alignment with the company's vision, mission, values, and goals.Establish and maintain strong relationships with key stakeholders, clients, prospects, partners, vendors, and industry associations, representing PHC as a thought leader and trusted advisor.Knowledge of the principles and practices of health planning and management sufficient to manage, direct and coordinate the operation of a managed care organization.Knowledge of the purposes, organization and policies of health systems sufficient to interact with other health care systems and providers.Knowledge of the policies and procedures sufficient to direct full health plan and claims operations effectively.Knowledge of the principles and practices of employee development sufficient enough to ensure organizational productivity, employee retention, and employee development.Knowledge of stop loss insurance and insurance agency development, growth and operations sufficient to develop, nurture and grow in support of PHC’s business plans.Establishing and maintaining effective working relationships with employees, policy-making bodies, third party payors, hospitals and other health care organizations, patients and the public.Drive innovation and continuous improvement in all of the Company’s solutions, leveraging technology, data, analytics, and best practices to enhance service delivery, quality, and efficiency.Attends and provides management guidance to the Board of Directors, leading all planning and strategy development.Ensure compliance with all applicable laws, regulations, policies, and standards.Provides developmental leadership in the creation and operation of PHC’s Third Party Administration, insurance agency, and stop loss marketplace programs in the support of Eliance Health Solutions and Penn Medicine.Identifies and finalizes development of business relationships with third parties that are consistent with the overall business plans and objectives of PHC for Board approval.Supports PHC’s Quality Management Committee as needed and oversees administrative follow-up for problems and issues identified and led by the Medical Director.SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:Manages and oversees all leadership staff and their activities.Approves all hires, reviews, promotions and discipline for all staff.Other duties as assigned.

JOB REQUIREMENTS

MINIMUM REQUIRED QUALIFICATIONS:

Bachelor's degree in business, health administration, or related field.Minimum 10 years of senior leadership experience in group health TPA, health insurance, or managed care industry, with proven track record of delivering results.Strong business acumen, financial management, and analytical skills, with ability to develop and execute sound business strategies and plans.Exceptional communication, presentation, and interpersonal skills, with ability to influence and collaborate with diverse stakeholders at all levels.Demonstrated leadership, coaching, and team-building skills, with ability to inspire and motivate others.Highly innovative, creative, and adaptable, with ability to embrace change and drive transformation.

PREFERRED QUALIFICATIONS:

Master's degree preferred.

COGNITIVE REQUIREMENTS

Attention/Concentration: The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others:

The position requires strong concentration skills.  The individual must have the ability to voluntarily sustain concentration to a task over an extended period of time as a result of an effortful and usually deliberate heightened and focused state of attention.

New Learning and Memory: The following level of ability is essential for the jobholder to learn and retain material:

A large portion of this position required reliance on verbal memory and new learning.  Efficiency in processing of verbal information, either in written or spoken form, is a major requirement and prerequisite of the job.  The individual must be able to attend to and process multiple bits of information simultaneously.  The individual must be able to organize and categorize this information effectively so that later recall is feasible.

Problem Solving, Reasoning and Creative Thinking: The following level of ability that is essential for the jobholder to think (in order to solve a problem) by combining two or more elements from past experience or imaginative thought:

The position required much autonomy of thought and problem solving.  The individual must be able to apply principles of logical or scientific thinking to define problems.  The individual must be able to think abstractly, which is manifested in the ability to form concepts, use categories, generalize from single instances, apply procedural rules and general principles, and be aware of subtle or intrinsic aspects of a problem.  The development of hypothesis and potential solutions to problems involves careful interpretation, analysis and diagnosis.  The individual must be able to collect data, establish facts, and draw valid conclusions.  The individual must be able to think creatively with a degree of inventiveness, experimentation and intuition.  They must be able to deal with a variety of concrete and abstract variables.

APTITUDES:  The following are essential requirements of the position in relation to job-worker situations.  These items describe how a worker must adapt, adjust, conform or act:     

Leadership, control and planning: Ability to accept responsibility for leadership, direction, control, planning, negotiating, organizing, directing, supervising, formulating practices, or making final decisions.

Variety and change: Ability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure involving significant differences in technologies, techniques, procedures, environmental factors, physical demands, or work situations.

Communication:  Ability to exchange information with others clearly and concisely; to present ideas, facts and technical information.

Interpersonal relations: Ability to maintain relationships that facilitate task accomplishment; to cooperate and resolve conflicts; to recognize needs and be sensitive of others.

EQUIPMENT USAGE REQUIREMENTS

Equipment/Tools: Computer, Phone, Copier, Printer, Fax, Office Supplies

Software: Microsoft Office Products, clinical information system

PHYSICAL REQUIREMENTS

Rarely 0-10%; Occasionally 11-35%; Frequently 36-70%; Continuously 71-100%

Body Position/Movement:  

Sit: FrequentlyStand: OccasionallyWalk: FrequentlyBend: RarelyPush: RarelyPull: RarelyKneel/Squat: RarelyReach: RarelyTwist: RarelyBalance: RarelyClimb: Rarely

Lifting: Degree of physical exertion is:

Light, exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to move objects.

Sensory Abilities specifically required:

VisionHearing

PHYSICAL ENVIRONMENT

WORKING CONDITIONS: Exposure to hazardous conditions/ materials is negligible.          

Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job.  It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards.  The percentages of time spent performing job duties are estimates, and should not be considered absolute.  The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole.  Incumbent must be able to perform all job functions safely.

Benefits At A Glance:

PENN MEDICINE LANCASTER GENERAL HEALTH offers the following benefits to employees:

100% Tuition Assistance at The Pennsylvania College of Health SciencesPaid Time Off and Paid HolidaysShift, Weekend and On-Call DifferentialsHealth, Dental and Vision CoverageShort-Term and Long-Term DisabilityRetirement Savings Account with Company MatchingChild Care SubsidiesOnsite Gym and Fitness Classes

Disclaimer

PENN MEDICINE LANCASTER GENERAL HEALTH is an Equal Opportunity Employer, committed to hiring a diverse workforce. All openings will be filled based on qualifications without regard to race, color, sex, sexual orientation, gender identity, national origin, marital status, veteran status, disability, age, religion or any other classification protected by law.

 

Search Firm Representatives please read carefully: PENN MEDICINE LANCASTER GENERAL HEALTH is not seeking assistance or accepting unsolicited resumes from search firms for this employment opportunity. Regardless of past practice, all resumes submitted by search firms to any employee at PENN MEDICINE LANCASTER GENERAL HEALTH via-email, the Internet or directly to hiring managers at Penn Medicine Lancaster General Health in any form without a valid written search agreement in place for that position will be deemed the sole property of PENN MEDICINE LANCASTER GENERAL HEALTH, and no fee will be paid in the event the candidate is hired by PENN MEDICINE LANCASTER GENERAL HEALTH as a result of the referral or through other means.