Process and Integration Advisor

Triple-S; Guaynabo (PR); On-site; USD 90,000 - 130,000; Full time

Job summary

Triple-S is seeking a senior leader to translate executive Clinical Operations goals into actionable roadmaps, scalable staffing, and integrated workflows across Utilization Management, Case Management, and Population Health. The role requires leading cross-functional teams, managing vendor relationships, and driving performance to deliver high-quality, cost-efficient care.

A bachelor’s degree in a health-related field and 3+ years in managed care are required, with PMP/Lean Six Sigma/CPHQ

Qualifications

• Bachelor’s degree in health care administration, business administration, Public Health, Nursing or related field.
• Minimum of 3 years in progressively responsible in managed care and/or insurance environment.
• PMP, Lean Six Sigma Green/Black Belt or CPHQ certification preferred.

Responsibilities

• Translate high-level VP vision into a concrete, multi-quarter execution roadmap and prioritize initiatives.
• Design and oversee departmental resource allocation, staffing models, and operational frameworks.
• Identify cross-functional dependencies, bottlenecks, and risks; design mitigation strategies to keep projects on time and budget.
• Monitor processes to drive operational excellence and lead innovation to improve clinical outcomes and reduce cost of care.
• Manage high-level relationships with external clinical leadership and key vendors, ensuring SLA compliance and strategic alignment.
• Drive cross-functional synergy by integrating UM, CM, and Population Health under standardized, data-driven collaboration.

Skills

Leadership

Strategic Planning

Stakeholder Management

Cross-functional Collaboration

Operational Excellence

Education

Bachelor's Degree in Business Administration or Public Health

PMP / Lean Six Sigma / CPHQ (preferred)

Job description

At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers.

When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.

Let’s build healthier communities together.

Job Summary

Serves as a critical bridge between executive leadership vision and departmental operational execution. Responsible for driving organizational performance by translating high level Clinical Operations Strategic Goals into actionable roadmaps, scalable staffing models and aligning the operational workflows. Act as the end-to-end owner of complex clinical initiatives, will spearhead the integration of Utilization Management (UM), Care Management (CM) and Population Management into a unified, high-performance ecosystem. Be a proactive leader capable of orchestrating cross functional dependencies, managing high stakes – vendor relationships, and fostering a culture of accountability, innovation and integration.

Essential Functions

• Translate high-level VP vision into a concrete, multi-quarter execution roadmap, prioritizing critical initiatives to maximize operational efficiency and enterprise-level strategic goals.
• Design and oversee departmental resource allocation, staffing models, and operational frameworks to ensure scalability and sustainable growth.
• Translate high-level VP vision into a concrete, multi-quarter execution roadmap, prioritizing critical initiatives to maximize operational efficiency and enterprise-level strategic goals.
• Design and oversee departmental resource allocation, staffing models, and operational frameworks to ensure scalability and sustainable growth.
• Architect sophisticated mechanisms to identify cross-functional project dependencies, potential bottlenecks, and resource constraints; design and execute mitigation strategies to ensure projects remain on time and within budget.
• Continuously monitor processes to drive operational excellence, proposing and leading innovation projects that improve clinical outcomes and reduce cost of care.
• Manage high-level relationships with external clinical leadership and key vendors, driving clinical and operational performance, service level agreement (SLA) compliance, and strategic alignment with organizational clinical objectives.
• Drive cross-functional synergy by integrating Utilization Management (UM), Case Management (CM), and Population Health (Pop Health) under a unified culture of standardization, data-driven collaboration, and clinical excellence.
• Support the Associate CMO on tactical implementation with stakeholders.

EDUCATION

• Bachelor's Degree in Business Administration or Public Health

Experience

• Bachelor’s degree in health care administration, business administration, Public Health, Nursing or related field. Minimum of 3 years in progressively responsible in managed care and/or insurance environment.
• Preferred certification on PMP, Lean Six sigma Green Black Belt or CPHQ or a combination.

LICENSES AND CERTIFICATIONS

• PMP - Project Management Professional (preferable)
• Lean Six Sigma - Green Belt

COMPETENCIES

• Action Oriented
• Customer Delight (Employee)
• Instills Trust
• Manages Ambiguity
• Collaborates

It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.

Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees.

We encourage Veterans and Disabled to Apply.