Associate Chief Operating Officer, Health Plan Services - Health Plan Services

Cook County Health

Full-time - Mid Level

Hospitals

About the position

The Associate Chief Operating Officer, Health Plan Services, plays a pivotal role in leading the operations of health plan services, specifically focusing on Medicaid Managed Care Plan product lines, Medicare Advantage Plan Services product lines, and other lines of business (LOB). This position collaborates closely with the Chief Operating Officer (COO) to oversee Third-Party Administrator (TPA) contractors and all associated vendors and delegates. The Associate COO is responsible for working with Cook County Health (CCH) financial planning staff and medical group leaders to develop, monitor, and evaluate operating costs and external expenditure budgets, ensuring optimal financial and operational performance of the CCH managed care system. This role also entails managing all relations with TPAs, delegates, and vendors, which are external contracted entities. In addition to operational oversight, the Associate COO is involved in various administrative responsibilities, including collective bargaining, discipline, and supervision. This includes reviewing applicable Collective Bargaining Agreements, participating in negotiations, documenting and recommending disciplinary actions, and managing CCH staff to ensure the systemic development and success of the organization. The position requires independent judgment to identify operational staffing issues and needs, and to perform functions such as hiring, transferring, and promoting employees in accordance with applicable agreements. The Associate COO will assist in leading the operations of health plan services, providing support to the COO in directing, managing, and coordinating provider contracting and relations. This includes developing and implementing programs that support established patient satisfaction targets, monitoring and evaluating performance objectives, and resolving operational issues such as timely claims payments and effective call center operations. The role also involves analyzing trends in enrollment, growth, retention, and expenditures, and developing resolution plans for overall health plan operations. The Associate COO collaborates with the COO to facilitate plan requirements with managed care initiatives and is accountable for achieving defined objectives related to membership, financial performance, regulatory compliance, member satisfaction, and quality outcomes.

Responsibilities

• Assist in leading the operations of health plan services for Medicaid Managed Care Plan product lines and Medicare Advantage Plan Services product lines.
• Support the COO in directing, managing, coordinating, and assuring implementation of provider contracting and relations through working with TPAs, delegates, and vendors.
• Develop and implement programs that support achievement of established patient satisfaction targets.
• Create tools for monitoring and evaluating performance objectives and compliance for all contracts, including TPA and provider contracts.
• Manage and resolve operational issues, ensuring timely claims payments and proper functioning of call centers.
• Identify and monitor trends in enrollment, growth, retention, and expenditures.
• Develop and implement resolution plans for overall health plan operations.
• Collaborate with the COO to facilitate plan requirements with managed care initiatives.
• Analyze and report on the status of functional services and care provided outside the health system.
• Work with the COO to develop systems that integrate member health planning and care delivery.
• Assist with care delivery strategy and operations in partnership with the CCH managed care Medical Director and Director of Business Development.
• Accountable for achieving defined objectives including membership, financial, regulatory, member satisfaction, and quality outcomes.
• Ensure implementation of provider contracts meets access, accreditation, and regulatory requirements.
• Achieve and exceed performance expectations for managed care operations consistent with TPA and provider contractual performance measures.
• Perform other related duties as requested.

Requirements

• Bachelor's degree from an accredited college or university.
• Five (5) years of Managed Care experience in Medicaid and Medicare.
• Four (4) years of management experience with at least three (3) years of experience at a director level or higher in a healthcare environment.
• Experience and knowledge of health plan operations and demonstrated ability to achieve results on both strategic and operational levels.
• Experience and working knowledge of quality assurance, resource management, health plan regulatory and licensing processes including federal and state laws and regulations.

Nice-to-haves

• Master's degree from an accredited college or university.
• Prior experience in a leadership role within an urban, publicly supported health system.