Director, Administrative Health Plan Operations
Job description
Periodic travel required, candidates that live in either area of New York State are encouraged to apply! This position can position can be located in Syracuse, Rochester, Rome, Buffalo, or Latham office in New York State.
Position Description: The Director, Administrative Health Plan Operations is responsible for working collaboratively with the Health Plan leadership team as applicable to plan for, supervise and evaluate health plan operations for all managed care plans. The Director, Administrative Health Plan Operations has strong competency in interdisciplinary teamwork, quality improvement, evidence-based practice, member-focused care, and informatics.
Performance Responsibilities and Standards:
Operations:
- In collaboration with Department Managers, responsible for directing, planning, organizing, supervising, and coordinating the services of Operations across all departments for all health plans including MLTC, D-SNP, I-SNP, and MAP.
- Develop, review and update policies, procedures, process improvement, training, and evaluation that help support efficient care management, care coordination, Utilization Management, Quality Improvement and Education.
- Utilizes Operational Reports and other informatic applications to monitor managed care operations. Collect, organize, and summarize data for performance measurement, internal and external reporting, and decision-making. Monitors and ensures clinical and operational performance goals are maintained across Nascentia health plans.
- Demonstrate knowledge of quality improvement process, i.e., clinical, and operational record audit, utilization review.
- Interpret government regulations and guidelines as needed.
- Provide oversight and leadership for clinical and operational projects.
Supervision and Education:
- Directly supervises Care Coordinator Supervisors, Education Specialists.
- Completes performance evaluations in a timely manner.
- Participates in interviews, hiring, performance evaluations for designated areas of direct oversight.
- Coordinates and leads team meetings for areas of direct oversight.
- Supervise department workload and other related tasks of functions of Care Coordinators.
- Observe and evaluate department performance and ensure that Managed Care Plan standards are met and ensures compliance with all regulations and contractual obligations.
Education:
- Collaborates with managerial and other essential personnel to conduct needs analyses, resolve issues, identify, and close performance gaps, and facilitate change.
- Collaborates with health plan Care Management to develop and implement education based on departmental policies and procedures.
- Design training curriculum and selects appropriate delivery method.
- Develops yearly managed care education plan.
- Directs educational program that promotes professional excellence for all roles in managed care.
- Develops and implements evaluation system to monitor the quality of the training delivery.
- Responsible for seeking more effective methods and content to ensure delivery of high-quality education- including collaboration with health plan leadership team, serves as a resource to plan and assists in the development and implementation of programs to meet these needs.
- Participate in special projects and performs other duties as required.
Job Qualifications:
- Bachelor’s degree in nursing, physical or occupational therapy, Health Sciences OR related degree OR equivalent experience including. At least 3 years of experience in managed care or a related area.
- Must have knowledge of teaching and training techniques.
- Must be able to present the subject matter effectively.
- Ability to collaborate with many cross functional teams.
- Ability to work and communicate in a fast-paced environment.
- Proficiency in the use of computers and software programs for communication and EMR, and various audio-visual equipment and software programs.
- Strong oral presentation and written communication skills
- Strong organizational, prioritizing and delegation skills required as well as strong interpersonal and relationship skills required.
- Knowledge of HIPAA and state regulations for managed care.
- Abstract thinking
- Ability to be non-judgmental.
- Ability to work proactively and independently.
Physical Requirement:
- Speech, visual, and hearing ability sufficient to express and comprehend written and verbal communication.
- Frequent sitting, standing, walking & driving.
- Pushing, pulling, reaching, kneeling
- Ability to lift and move objects up to 40 pounds.
- Bloodborne Pathogens Exposure Category III – Employee who rarely has contact with blood and body fluids.
Compensation & Benefits:
Competitive Salary with:
- 401K with generous Employer match
- Medical, Dental, Vision plans
- On-Site Employee Fitness Center and Gym Membership
- Partially funded HSA
- Paid Time Off and Extended Sick Leave
- Short/Long term Disability
- Exceptional work/life balance
- Employee Assistance Program (EAP)
- Much More!
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About Nascentia Health:
Nascentia Health is leading the way in home care, post acute care and long-term community health. A healthcare system without walls, Nascentia is an innovator in the concept of healthcare, truly focused on the patient as a whole. By serving people in their homes, Nascentia Health is able to provide true holistic care. We can address immediate needs, help support positive long term medical and lifestyle choices that provide for better outcomes, leverage cutting edge in-home care technologies, and help avoid unnecessary visits to busy healthcare facilities.
Our employees are our greatest asset. They work hard every day to make our system amazing and are dedicated to our mission of being the premier home and community-based care system for the regions we serve. We want everyone to love what they do, be excited about coming to work, and take pride in being part of our team.
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Nascentia Health is an Equal Opportunity Employer (EOE)
Employment is contingent upon negative results of a pre-hire drug screen
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