This position isresponsible for directly overseeing all fiscal and administrative operations, including oversight ofnetwork, community outreach, grievance andappeals, member services,claims payment and billing,information technology andreporting. Responsible for the overall management of the health plan, including development of policy and procedure, management of communitysupport delivery system withinbudgetary goals, and coordination of relationships with the state, planmembers and members in care, participating providers, partners and the community.
- Directly oversees all fiscal and administrative operations, including the areas of network, community outreach, grievance and appeals, member services, claims payment and billing, information technology and reporting.
- Has authority to commit to expenditures within the authority delegated by leadership.
- Leads business operations which includes collaborating with the clinical and program staffs to ensure that high quality services are delivered within budget, that system principles are supported with financial resources; and determining information technology requirements and overseeing plans and budgets for implementation, production and operation.
- Has responsibility and authority over all daily administrative and fiscal operations. This includes decision-making authority for controlling fiscal expenditures and ensuring that operations support system requirements.
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- 10 years of experience in healthcare with a clinical and/or operations management focus.
- 4 years of management level experience in the managed healthcare industry required.
- Knowledge of managed healthcare delivery systems to include critical components and interdependencies.
- Knowledge of the variety of financial and operational structures viable in the managed care arena.
- Knowledge of operational issues unique to the delivery of integrated care delivery, population management, strategic planning and the budget process.
- Ability to communicate and advocate at the consumer engagement level and up through corporate staff levels including the CEO.
- Strong leadership skills.
- Must possess strong analytical and organizational skills in a multiple site and function environment.
- Proven ability to manage operations in a larger matrixed healthcare system. Negotiating and contracting skills.