IBM Watson Health - Program Integrity Director in DES MOINES, Iowa

Job Description

Watson Health’s Iowa Program Integrity Project Director is the Client Services Director/Account Executive. The solution the Watson Health team will provide involves a combination of consulting resources and technology resources. This position will organize and oversee the workload of up to five functional teams and will serve as the primary customer facing liaison between Watson Health, its subcontractors, and the State. The Project Director is responsible for communication, coordination, process documentation, resource allocation, outcomes reporting and overall customer satisfaction.

Responsibilities:

  • Provides leadership and direction for the implementation and ongoing operations of the team’s fraud, waste, and abuse detection and elimination efforts.

  • Establishes goals and objectives for the functional teams, based on the needs of the Customer.

  • Leads the team meetings and client meetings. Works with each team manager to set priorities for analysis, investigation, audit and case disposition.

  • Establishes a strong collaborative relationship with the Customer and the managed care organizations, and participates in frequent meetings to discuss strategy, approach, prioritization of workload and outcomes.

  • Ensures that subcontractors are performing consistent with contract expectations and addresses any issues that may arise.

  • Develops and implements effective communication avenues and workflows throughout the fraud and abuse identification, investigation and resolution process.

  • Designs effective reports and metrics that will demonstrate Return on Investment (ROI) to the Customer.

  • Collaborates with the Project Manager to prepare required contract deliverables, such as the Communications Plan, Project Plan, Risk Mitigation Strategy and other documents.

  • Prepares presentations for the Customer and other stakeholders to demonstrate progress in achieving contract objectives.

  • Coordinates or facilitates meetings with the Customer and other Stakeholders to obtain input for the Fraud and Abuse Detection System (FADS).

  • Integrates activities with the Technology Team and ensures that the functional teams participate in the configuration, implementation and ongoing support of the software tools, including DataProbe.

  • Monitors contract, budget and resource needs and communicates any challenges to the Watson Health Regional Vice President.

  • Provide leading-edge healthcare information services at the strategic partnership level of our clients’ organizations.

  • Enhance Watson Health's partnership with and value to each client through increased relationships with their middle and senior management.

  • Effectively collaborates with consultants hired by Watson Health to support growth initiatives, and effectively drives work for consultants to facilitate account growth.

  • Develop service agenda based on customer’s business needs and work flow which would include any or all of the following: cost savings, profit-improvement strategies, workflow enhancement, productivity improvement, employee/member/constituent/ beneficiary health status improvement, detection of fraud or other payment irregularities; implement contracted services; document return on investment.

  • Manage financial and business objectives including contract revenue, value-add revenue, renewals, expenses and margins and accounts receivable targets.

  • Lead client team to perform consulting engagements and engage in billable consulting activity, as appropriate and/or required.

  • Manage evolving client expectations, needs and priorities, and collaborate with client team members to ensure effective integration with consulting and service delivery capabilities and priorities.

  • Manage and monitor client satisfaction, and recommend appropriate strategies, tactics and operational initiatives to continuously enhance client satisfaction.

  • Continuously search for, recommend and implement process improvements; take a leadership role in fostering a quality improvement mindset.

  • Manage and develop team members to their highest potential performance level. Provide regular and ongoing coaching around annual objectives and priorities as well as routine and unique business requirements. Provide formal feedback according to the established Watson Health's performance management processes. Manage team interactions to obtain optimal team performance.

  • Collaborate with peers to ensure sharing of knowledge and best practices.

Examples of responsibilities:

  • Develop departmental and account-specific budgets

  • Lead contract renewal negotiations with clients

  • Participate in capabilities presentations for new sales opportunities

  • Develop value-add sales opportunities

Required Technical and Professional Expertise

  • Master’s degree (e.g., MBA, MPHA) or equivalent education and experience

  • Medicaid program integrity expert

  • 10+ years of experience in healthcare information consulting/systems, with client contact at senior levels and demonstrated business development skills.

  • Proven history of ability to capture the attention and respect of senior management and the C-suite in the client environment by providing new and useful ways of managing human capital.

  • Current or prior responsibility must have included revenue accountability in the $2,000,000 - $10,000,000 range.

  • Superior understanding of both new business development and consulting methodology.

  • Superior presentation and communication skills.

  • Extensive staff development and supervision skills.

  • Ability to work across the organization, including Product Development, Sales, and Product Support functions to ensure that both current and future client needs are anticipated and met.

  • Willingness to travel.

Preferred Tech and Prof Experience

  • Prior Iowa Medicaid program integrity and/or policy experience a plus.

  • Prior Iowa Medicaid Management Information System experience a plus.

EO Statement

IBM is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. IBM is also committed to compliance with all fair employment practices regarding citizenship and immigration status.