Director Health Plan Operations
Job ID 2013-21734 # Positions 1
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 1/16/2013
Additional Locations ..
More information about this job:
The Director Health Plan Operations will be responsible for health plan dashboards, operations policies, OPEX, best practices and regulatory compliance. The incumbent will build strong working relationships with plan senior management and home office support areas to assist in meeting the goals of the organization. In addition, the incumbent will demonstrate high levels of flexibility by managing projects at the health plan based on strategic priorities. The incumbent will be responsible for identifying and prioritizing health plan opportunities for improvement in the areas of efficiency and effectiveness.
1. Partners and supports leadership across the health plan on assigned projects ensuring company goals and initiatives are met.
2. Participates in Operational process improvement initiatives and facilitates collaborative effort between Health Plan and Corporate operations for implementation.
3. Demonstrate understanding of process improvement methodology (i.e. Six Sigma certification) and completes projects within appropriate timeframe as directed by management.
4. Works with health plan leadership and serves as primary contact to ensure appropriate key operational indicators are in place for monitoring and analysis.
5. Maintains health plan dashboard of key operational indicators, identifies and reports issues to management.
6. Works with management to identify opportunities for Operational Excellence and to create seamless processes between home office and the health plan.
7. Works with health plan leadership and home office support areas/account managers to resolve operational issues to include enrollment, benefit configuration, call metrics, authorizations, high dollar claims, pended claims, CAMP, appeals, adjustments, customer service and policy issues.
8. Assists Health Plan Provider Relations with the contracting process and resolution of defects resulting from the provider contract request, configuration and implementation processes which results in claim payment inconsistencies or inefficiencies.
9. Engages in corporate cost containment initiatives by identifying opportunities to maximize dollar recovery.
10. Maintains awareness of home office initiatives to ensure priority alignment and promotes health plan communication and collaboration.
11. Recognizes and utilizes appropriate channels for communication, encourages two-way communication with Plan and home office staff to participate in creative program development resulting in improved efficiency and enhanced job performance.
EDUCATION AND EXPERIENCE
- Bachelor’s Degree or equivalent experience in Business, Health Care or related field.
- Master’s Degree
Years and Type of Experience Required:
- Minimum of seven years work related experience.
- At least 3 years of management or leadership experience 2-4 years of demonstrated experience in data assimilation & analysis.
- Experience with change management.
CERTIFICATION AND LICENSURE
- Black belt quality certification.
Knowledge and Skills
- Excellent analytical, organizational, problem-solving, and communication skills.
- Ability to demonstrate political sensitivity and to work effectively with senior level management as well as with multi-disciplinary teams across department lines.
- Demonstrated leadership in healthcare operations including claim payment and root cause identification.
- Strong leadership, coaching, and staff development skills.
- Strong knowledge of data management and interpretation.
- Conflict resolution/mediation experience.
- Clinical or coding skills a plus.
- Quality training a plus.
- Must be able to operate a computer.
- Must be able to operate a phone.
- Ability to travel a minimum of 25%, as require.
- 2 years ago - save job
AMERIGROUP looks after the health of America's needy. The managed health care provider targets people eligible for Medicaid, the State...