Coo Jobs

About The Position

Requirements

• Bachelors' degree in Business, Health Services
• Master's Degree in Business, Policy, Public Administration or Health Services Administration or related field.
• 15-plus year's progressive healthcare experience.
• Direct experience in the managed care industry
• 10+ years of managed care with Medicaid and Medicare managed care plans.
• Management experience.

Nice To Haves

• Master's or PhD Degree in public health, social or behavioral services or similar discipline
• 10+ years in public health, social or behavioral services, or similar field
• 3+ years in a direct or matrix leadership position

Responsibilities

• Serve as Health Plan point of contact
• Ensure all Shared Service areas and Functions understanding priorities and issues for the Health Plan.
• Collaborate with Shared Services to ensure they understand and are fulfilling Health Plan requests and commitments
• Formulate and implement business plans, tactics and strategies to provide for the efficient, effective and compliant operations to meet short-term objectives/obligations and ensure long term growth and success.
• Develop and implement adequate measures to meet the operational needs of the company, to efficiently utilize its resources, and to maintain an effective system of operational processes & outcome measurement.
• Create new policies and amend existing policies to improve operations as needed. Present reports and recommendations on the operations of the state plan and propose changes to major policies.
• Identify and drive new initiatives to optimize systems' performance and leverage functionality to: Increase claims payment accuracy and auto-adjudication, Increase members and provider satisfaction, Identify and implement cost savings initiatives in contracting, operations and employee productivity, Avoid work-arounds and unplanned re-work.
• Ensure the overall level of quality for operational and contractual obligations meet or exceed appropriate standards.
• Provide personal leadership that encourages employee productivity and responsiveness to the needs of the current and prospective members, providers and regulatory agencies/staff.
• Ensure programs are established to comply with all relevant federal, state and local regulations.
• Overall management of various departments/functions in multiple office locations which could include: Network Management and Operations, Health Plan Operations, Other Functional Areas as Needed
• Project Management
• Represent the Health Plan on various committees and work groups within the Shared Services Team
• Represent Health Plan on MHI Committees or Operational workgroups (e.g., VPs of Network Management monthly meeting, MHI Ops Quarterly meeting with Health Plan, etc.)
• Other functional areas as needed.

Benefits

• competitive benefits and compensation package