Description: As the service leader, the Director is accountable for facilitating and improving the end-to-end service experience within Colorado. Accountable for the supervision of non-clinical administrative staff across multiple operations. The Director will develop and lead a team of service professionals that clients at various touch points as part of their experience. The Director will have a working knowledge of customer satisfaction metrics and trends across clinical and non-clinical functions and in collaboration with HP and CPMG leadership, define and coordinate service improvement opportunities. The Director will ensure operations under their purview adhere to all applicable Regulatory requirements and meet all operational and performance guarantee targets.
- Provides overall leadership (responsibility and oversight/management) and strategic/operational planning to all service departments including budgetary, compliance, service and quality oversight of these areas
- Sets the strategic direction, operation vision, and implementation plans for the services functions. Works collaboratively with Regional and National Shared Service leaders in creating consistent processes, policies and protocols from an end-to-end perspective.
- Effectively communicates needs, issues, achievements, etc. to applicable leadership.
- Ensures compliance with all State and Federal regulations and promotes compliance among team members. Ensures functional performance above Regulatory, National and Regional targets.
- Ensures the achievement of all performance guarantee targets
- Ensures the timely reporting of operational performance metrics
- Ensures the successful execution of all audits performed within their purview
- Facilitates problem solving and conflict resolution of operational issues to ensure an extraordinary service experience to include serving as the escalation point for issue resolution.
- Establishes and maintains a world class customer focused service culture throughout the region by developing and maintaining customer-centric strategies and initiatives focused on managing the service experience collaboratively with other regional departments. Establishes working relationships with all functional areas within KPCO so as to create a positive service culture.
- Recommends to Health Plan and Medical Group management new or revised policies and procedures to improve service. Leads customer service initiatives that support strategic organizational goals and ensures the delivery of high quality, seamless service throughout the continuum of service touchpoints and experiences.
- Identifies opportunities to improve the efficiency/effectiveness of Health Plan functions, collaboration between Regional Health Plan functions and the National Shared Service functions, and customer service. Creates and implements strategy to maximize consumer engagement, communication and the overall experience based on feedback from parties inside and outside of immediate functional ownership. Develops and monitors operational and consumer satisfaction metrics in the assessment of existing performance and opportunities for improvement.
- Engages with contacts directly to seek outside intelligence on the performance of service functions and areas of opportunity.
- Hires, trains, supervises, counsels, disciplines, and terminates assigned staff as appropriate
- Communicates goals, objectives, accountabilities, priorities, and authority parameters to assigned staff.
- Establishes goals and objectives for the functional units within service area in alignment with the Region's strategic objectives and executes on a plan to achieve the objectives in a timely manner.
- Performs other duties as assigned.
- Minimum five (5) years business function management in a health care setting, health care administration, medical administration OR equivalent related experience managing large, complex operations functions in a Health Care setting.
- Minimum three (3) years management experience. Education
- Bachelor's degree in business administration, health care or related field OR four (4) years of experience in a directly related field required.
- High School Diploma or General Education Development (GED) required. License, Certification, Registration
- Demonstrated experience and skill in strategic planning in a multi-faceted health care or service industry system, leadership, collaborator ability to determine the key business issues and to develop appropriate action plans from multi-disciplinary perspectives, ability to envision, create and implement new program design, project management plans and strategic plans.
- Demonstrated experience and skill in working with senior level managers. Knowledge of the fundamentals and dynamics of business process re-design.
- Demonstrated experience and skill in communication, facilitation, presenting, planning, organizing, problem solving, analysis and attention to detail.
- Previous experience in a managed care setting preferred
- Experience working in a Labor Management Partnership environment.
- Ability to be proactive and champion innovation and change.
- Knowledge of health plan benefits, contracts and services.
- Knowledge of clinical level activities.
- Strategic planning experience in a managed care organization.
Job Number: 629528