Primary Purpose of Position
The Service Center Executive Director will reports directly to the Cardinal Innovations Healthcare Solutions Chief Financial Officer (CFO). This role will oversee the operations of the entire Service Center, which will include account management, customer service, provider enrollment, claims processing and operational reporting. The Service Center Executive Director will ensure operational compliance with contract, federal, state rules and regulations, as well as with Cardinal Innovations’ operational policies and procedures. The Service Center Executive Director will provide vision, leadership, planning, project coordination and management for the development of a cost-effective organization while concurrently facilitating efficient operations to meet current and future business needs within the Service Center. This role is responsible for analyzing and directing all function-related activities within the scope of the Service Center.
Responsibilities and Duties
The Service Center Director is responsible for (though not limited to):
Supervision Received by Employee
- Oversight of all operations/functions of the Service Center, including management, budgetary and community involvement responsibilities; support and advise to management regarding account management, customer service, provider enrollment, claims processing and operational reporting and ensuring consistency in business practices and service delivery.
- Participation in the development of an annual plan of work and will be responsible for implementation and achievement of performance goals across areas of responsibility.
- Collaboration in the development of a risk management plan that identifies key risk indicators and strategies to address performance problems below identified thresholds. Implement strategies across areas of responsibility.
- Ensuring customer service and management of multiple clients is priority to leadership of the Service Center.
- Development of plans of work with direct report senior management that reflect priorities and initiatives.
- Ensuring all policies and procedures are implemented appropriately and monitored regularly. Ensure that policies and procedures are up to date, and are followed across areas of operations. Process maps are used to define activities and are the basis for procedures and information systems design change requests.
- Ensuring that procedures are designed and implemented to comply with contract requirements of all funding entities. This includes Medicaid contracts as well as contracts for state and federal funds. Requirements and criteria for performance are managed to ensure performance meets requirements.
- In collaboration with the CFO, assisting in the development of the service center budgets according to utilization projections and utilization management goals. Monitor expenditures and forecasts to ensure funding is spent in accordance with plans, or determine changes in budget need to accommodate service center utilization.
- Ensuring there are processes in place that analyze unexpected claims patterns, including trends in denials patterns.
Ensuring departments maintain activities and performance levels required for National Committee for Quality Assurance (NCQA) accreditation.
- Establishment of key performance indicators, performance targets, and thresholds that indicate both desired performance and risks to the health of the organization. Identify reports needed to monitor performance, and frequency for monitoring. Ensure a system for ongoing monitoring of system performance is in place, and action is taken to address performance that is below target or at a risk level.
- Identifying areas where there are system issues that impact the performance of the organization.
- Demonstrate leadership in the initiation of collaborations with other organizations, support innovations in practice and service delivery which produce better outcomes.
- Maintenance and development of a highly skilled and motivated staff.
This position is highly independent. The employee is expected to independently establish work priorities and determine necessary activities in order to meet job requirements. Periodic planning and monitoring sessions will be held with the Chief Financial Officer (CFO).
Knowledge, Skills and Abilities
Required Training and Education
- The Service Center Director must be process oriented with business operation acumen and demonstrated ability to empower others to perform at the highest level of their ability. The Service Center Executive Director must stay abreast of important federal and state trends and activities that could potentially impact the business. Additionally, the Service Center Executive Director must fully grasp the position of business within the marketplace; demonstrate a thorough understanding of capabilities and new service opportunities.
- The Service Center Executive Director must have strong administrative skills in order to coordinate the scope of activities, staff and providers under the management of the agency.
- The Service Center Executive Director must be cognizant of the complex funding system that is under local management, including accountability to the state mental health and Medicaid agencies.
An undergraduate degree is required, though a master’s degree is highly preferred. Candidate must have at least ten years of progressive experience in management. Managed care and/or shares services experience is highly desired.
Cardinal Innovations is North Carolina’s largest Managed Care Organization providing Medicaid managed care and state-funded behavioral health plans. Our mission is to enhance the health and well-being of individuals and their families by creating and managing quality healthcare solutions for those who depend on the public system for care. Our plans reflect the uniqueness of our local communities and are capable of making continual adjustments and improvements to meet the changing needs and priorities of our clients. Cardinal Innovations values the contribution of all stakeholders, and our businesses are based on the principles of respect, collaboration, and mutual accountability.
Cardinal Innovations is an Equal Opportunity Employer. Visit our website at www.cardinalinnovations.org to view all vacant positions and apply on line.
Cardinal Innovations Healthcare Solutions - 11 months ago