If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)
The Director of Operations will be for a variety of functions related to the including general management, business operations within a complex matrixed environment, and significant project/program management across the company and its businesses.
Has accountability for the operations in the Alaska Health Plan and matrix relationship management with Benefit Operations including but not limited to Claims, Member and Provider Services, Encounters, IT projects, Network - Services and Contracting, Appeals and Grievances. State Relationship/Contract Management.- Ensures Operations are in compliance with state Medicaid contract and reporting is timely and accurate.
This role will be responsible for management and administration of multiple functions, or management of business operations, managing daily operations of multiple levels of (direct; indirect & matrixed) staff and multiple functions and business units. Also, this role will have management leadership internal and external to organization and accountable for financial and non-financial results (budgets and actuals). Will have Project management and implementation leadership and oversight.
Accountable for the day to day and long-term operations for the health plan in Alaska Coordinated Care demonstration project
Working with Matrixed partners ensure strong launch of new health plan
Directs matrixed teams to resolve business problems that affect multiple functions or disciplines in order to ensure commitments to the state and provider partners are met.
Product, service or process decisions for customer (internal and external) related directly to the state of Alaska Medicaid contract
Analyze RFP/contract language and incorporate requirements into project plans
Assist internal and/or external business partners with completion of tasks and resolution of issues and problems with program implementation in regards to health plan operations
Establish and/or implement internal and/or external service level agreements in order to ensure ability to monitor and measure program performance (e.g., turnaround time; quality; effectiveness)
Identify and/or secure resources (e.g., funding; staffing; system security; real estate and/or telecommuting requirements; hardware/software) required to implement programs
Review, create, and/or maintain workflows to ensure they are up-to-date and operationally efficient
Provide guidance, expertise, and/or assistance to internal and/or external partners (e.g., claims; call center; benefits; clinical) to ensure programs and strategies are implemented and maintained effectively
Communicate with and help internal and/or external partners interpret contractual requirements in order to ensure effective problem solution and strategy implementation
Provide input to internal and/or external stakeholders (e.g., sales; shared business partners; pre-service vendors; facilities) in order to drive effective business plan and vendor management
Monitor project performance against internal and/or external service level agreements
Work with internal and/or external partners (e.g., claims; call center) to ensure accurate reports are produced to validate program
Review consolidated operational performance reports in order to determine overall effectiveness, make necessary changes, and identify opportunities for new programs or program consolidation or expansion
Analyze operational performance on relevant criteria (e.g., targeted financial metrics; quality indicators; performance guarantees and/or incentives
Build and demonstrate an understanding of relevant business areas' leadership, structure, responsibilities, and work flow
Conduct regular meetings (e.g., JOCs; QBRs) with relevant internal and/or external stakeholders to review and discuss updates and outstanding issues (e.g., project implementation readiness; compliance and/or quality audit results; out-of-compliance issues; staffing issues)
Develop corrective action plans to address and/or resolve relevant internal and/or external stakeholders' concerns or issues regarding operational issues
Conduct deep dive program reviews with relevant internal and/or external stakeholders to identify opportunities for continuous improvement
Ensure relevant internal and/or external stakeholders (e.g., vendors; providers; leased network) are provided with correct and/or updated processes, programs, and/or policies (e.g., fee schedules)
Partner with relevant internal and/or external stakeholders to develop and/or review
Monitor and/or report on-going compliance and related outcomes(i.e. claim denials, complaints, clinical metrics) to relevant internal and/or external stakeholders (regulatory, agencies, vendors)
Ensure internal partners and/or external vendors adhere to business and contractual agreements
Conduct end to end testing to validate adherence to RFP / contract requirements
Analyze budget performance and variances
Work with relevant internal partners (finance, actuarial) to identify resource requirements and/or create budgets and forecasts
Review and assign projects / initiatives based on resource capacity, capability, and expertise
5-10 years operations leadership with health plans and health systems
5+ years of project and or program management experience
Demonstrated experience in managing within a large complex matrixed management team
Prior government contract oversight experience; prior experience with RFP process
Budgeting and financial experience
Must have vendor management and oversight of vendor SLA
Skilled communicator with internal and external facing relationships
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.