DescriptionAbout the Role
The Market Director of Operations is a market-based executive that provides leadership, management and vision to effectively grow the local health plan, ensure operational effectiveness and efficiency, clinical outcomes optimization, and financial strength.
The Market Director is responsible for Health Plan operations and activities, is directly responsible for driving operational, financial outcomes and support clinical results of the local health plan, working in a highly matrixed environment with corporate partners. Will coordinate with Longevity Health Plan's executive team, Clinical RVP, Market Director of Clinical Services (MDCS) and local clinical team to achieve local goals in coordination with national and corporate objectives. The Market Director must reside in one of the states in which the Health Plan is licensed and the Market Director is assigned.
RequirementsKey Tasks and Responsibilities:- Establishes and maintains mutually beneficial relationships with local Skilled Nursing Facility partners and key healthcare providers in the market.
- Drives laser focus on improving the quality, affordability, and experience of health care for all patients as well as a relentless focus on improving the care delivery experience for providers.
- Oversee the delivery of key strategic initiatives and operational plans of Longevity Health Plan that drive operational quality improvement, member growth, earnings, and regulatory compliance.
- Monitors key metrics and trends in sales, risk scores, utilization, unit cost, clinical key performance indicators and other business drivers to understand the impact these factors have on financial performance and drive necessary actions to achieve performance objectives.
- Assists in the development of strategies to ensure continued growth and financial stability of the health plan in alignment with corporate objectives.
- Collaborate with Finance and Performance Analysis teams to identify cost savings initiatives and monitor contract performance.
- Controls expenses by gathering and submitting budget information, scheduling expenditures, monitoring variances, and implementing corrective actions.
- Implements operational changes in the market in concert with corporate and vendor operations to achieve financial and operations goals for both for the local plan in alignment with other Longevity plans nationwide.
- Provides strategic/tactical direction and support to Network contracting team to ensure a strategic and CMS adequate network that meets care, service, compliance, and financial goals.
- Develops market team facility visit schedules, assigns, and monitors work, ensures appropriate resources, implements productivity standards, resolves operations problems, maintains reference manuals, and implements new procedures.
- Maintains working knowledge of all market key metrics including MLR, APK, IP/OP costs, Admin costs, Hospice population, etc.
- Maintains documentation of market-based strategies and current partner interactions, barriers, action plans, etc. in order to drive increased engagement and high levels of I-SNP penetration.
- Assists in the development of market and building-specific monthly/annual enrollment targets.
- Supports Growth/BD Teams in communication with local Skilled Nursing Facility prospects.
- As assigned, oversees implementation of new partner Skilled Nursing Facilities utilizing market team and corporate resources as needed, setting go-live dates and ensuring necessary network agreements and clinical resources are in place.
- Creates an enrollment plan and productivity targets for each Sales Engagement Specialist in the market to grow plan membership.
- Collaborate with Longevity Health Plan and executive leadership to develop compensation plans for Sales Engagement Specialists and monitor on-going productivity against targets.
- Develop materials and presents during Regional Operating Review meetings, Business Development meetings and partner-facing Joint Operating Committee meetings.
- Maintains a regular visit schedule for assigned SNFs, visiting each at least quarterly and ensuring ongoing communication with all relevant owner/operator teams.
- In collaboration with the executive leadership team, oversees the integration and delivery of current product offerings and supplemental benefit offerings in the market.
- Understands and facilitates legislation/regulations affecting Longevity Health Plan in the market.
- Develops and fosters effective collaboration between corporate and functions managed directly by the market.
- Collaborate with colleagues in operational risk, compliance, and internal quality audit to ensure that robust policies and procedures are maintained and that risks are identified and addressed quickly.
- Functions as a champion of Compliance and collaborates with corporate teams to ensure that local staff and providers complete initial and annual Compliance, Model of Care, HIPAA, and FWA training.
- Represents Longevity Health Plan both in external forums and develop the Longevity Health Plan brand with regulators, providers, AHCA, and local healthcare partners.
- Performs other related duties as assigned.
Supervisory Responsibilities: The Market Director supervises all operations staff within their assigned market: (Licensed) Account Managers, Sales Agents, and Member Advocates.
- Responsible for recruiting, selecting, orienting, and training employees within assigned market.
- Manages staff performance ongoing and provides coaching, counseling, and discipline as needed.
- Leads a weekly markets team call in collaboration with clinical team and cohosts clinical-focused monthly meeting together with the Market Director of Clinical Services.
- Implements and enforces systems, policies, and procedures.
- Maintains a safe and healthy work environment by establishing and enforcing organization standards and adhering to legal regulations.
- Communicate with each market team member regularly, ensuring focus on team priorities and progress toward goals.
- Ensuring quality and customer service standards are followed by all market-based team personnel.
Credentials & Coverage:- Licensure is not required for this position but preferred. LNHA, Health Insurance License or Clinical board certification/license is highly preferred.
- Valid state driver's license with a good driving record and proof of automobile insurance required.
- Auto insurance coverage as required by your state of residence. New employees will be responsible for providing proof of coverage prior to hire and on an ongoing basis.
Education and Training:- MBA, MSN or advanced degree in health care management, nursing with business education or other relevant technical or operations field preferred.
Knowledge and Experience:- Minimum of 5-10 years of healthcare industry experience, with Medicare expertise required (either through health plan or provider organization).
- Strong local market knowledge of the skilled nursing home environment and experience in Medicare Advantage marketing and sales strongly preferred.
- Understanding of functional areas and their impact on overall performance (beyond operations, including clinical, finance, IT, compliance, and legal).
- Knowledge of the evolving health care delivery system, including expertise in population health management, Medicare health plan operations and value-based care delivery models, as well as a passion for improving the quality and affordability of health care for the frail and elderly living in nursing homes strongly preferred.
- Strong entrepreneurial drive along with the operational skills needed to consistently drive results.
- Excellent written and oral communication skills with internal and external business partners and employees.
- Independent decision-maker and calculated risk-taker.
- Strong strategic and analytical orientation with the ability to drive operational excellence and strong business performance.
- The ability to maintain relentless personal and team focus on achieving long-term objectives in the face of potential distractions.
- Excellent planning and problem-solving skills that enable quick identification and efficient resolution of issues.
- Highly collaborative with the ability to influence others and build strong professional relationships, especially in a highly matrixed organization.
