Senior Vice President, Medical Economics

3 weeks ago

Abu Dhabi, United Arab Emirates Daman - National Health Insurance Company Full time

Mandate of Medical Economics SVP

· Sets vision and drives tactical execution to design and optimize portfolio performance reporting and management.

· Partner with senior leadership for creative problem-solving and strategic decision-making involving medical cost improvement strategies.

· Lead the development of detailed statistical and financial models that communicate immediate and long-term projections of financial performance of new and ongoing initiatives and clinical programs to facilitate corporate decision-making and the development of strategies and goals.

· Forecast, predict and interpret financial results, including variances from budget, to help identify medical cost improvement opportunities and potential risks.

· Develop and gain support for data-based recommendations with team members from product, underwriting, commercial, clinical, network, investigations, and corporate functions.

· Recommend tailored population health manage and Outreach programs to help in improving healthcare spent.

· Run a population Health Quality programme for provider medical quality of care, including research studies with DOH.

· Oversee health insurance cost containment programme and coordinate the implementation of medical strategic direction.

· Leverage data to identify & analyse provider behaviours, abnormal spikes in utilisation at clinician/provider & policy level for commercial and regulatory business.

· Bring clarity to complex problems using exceptional communication skills when engaging with senior leadership and external stakeholders.

· Apply an understanding of complex mathematical concepts, methods, and applications in a variety of situations.

· Creatively leverage a wide range of datasets to inform key analyses and present solutions for complex problems to Daman key clients.

· Build strong relationships with Actuarial, Analytics, and Finance teams across Daman.

· Ensure that departmental work products meet the highest standards of quality.

· Build and maintain relationships with shareholders, key clients and regulatory authorities through meetings and negotiations.

· Submit all medical regulatory reports as required under the contractual obligations.

Role Purpose

Overarching duties as a Daman leader:

· Develop and implement department strategy following Daman strategy, set departmental and operational goals and initiate measures to reach goals and to improve department performance.

· Accountable for a result-oriented management considering cross-departmental performance/results.

· Manage and develop people and resources including provision of a strong leadership presence.

· Manage department expenditure and requirements minding the impact on the financial budget.

· Foster organisational culture by establishing quality awareness and service orientation and obeying consistent implementation of processes such as Project and Change Management

· Lead and influence the development, implementation and adherence of policies and procedures.

Department specific:

· Analyse medical cost utilization and unit cost data, identifying top trend drivers and affordability opportunities, developing strategies across cross-functional teams such as Clinical, Network, Authorization, and Claims, supporting the execution of those strategies, and evaluating program and initiative outcomes.

· Consult with management on strategies to manage the cost of health insurance.

· Manage and lead cost containment initiatives.

· Advise on opportunities for department cost containment and efficiency (cost centre management)

· Advise on the conceptualisation, research and creation of new population health programmes matching the need of the community in line with Daman strategy and goals.

· Drive high-visibility impactful analysis to control medical cost inflation.

· Ensure the preparation and delivery of medical management information and dashboards as per internal requests related to medical cost containment.

· Advise on suitable improvement of cost control initiatives and ensure adequate management/support of delivery.

· Advise and monitor new strategic medical initiatives in business development, i.e., provide medical information for decision making process, (co-)design strategy/concept and manage implementation.

· Lead presentations, negotiations and meetings with commercial key clients and regulatory authorities to build and maintain Daman business.

Key Requirements and Qualifications

· Minimum +15 years of experience in management level with high level of managerial skills and relevant experience

· Bachelor's degree in mathematics, statistics, actuarial science, economics, or related field required.

· Advanced degree in Business Administration and Healthcare Management are a plus

Skills and Competencies

· Deep knowledge and experience in utilising and developing tools, concepts and strategies that leverage new business opportunities with strong business understanding and background.

· Deep knowledge of data management, analysis and management reporting standards, statistics, process improvement methodologies and insurance processes

· Data retrieval and visualization skills and relational database experience.

· Experience in Value-based reimbursement, population health, segmentation/ stratification, etc.

· Knowledge in commercial and government health programs is preferred.

· Detailed working knowledge of healthcare networks

· Energetic, entrepreneurial, self-starter and capable of self-direction

· Strategic thinking with strong focus on results and high quality of work

· Very good leadership skills including people management, selection and development skills

· Excellent command of written/spoken English; knowledge of Arabic language is an added advantage

· Excellent analytical, planning, forecasting, execution and problem-solving skills

· Strong level of customer service orientation and professionalism in all interactions

· Excellent communication, negotiation and presentation skills

· Deep knowledge of health insurance concepts

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