Sr. Manager Provider Operations

The Sr. Manager of Strategic Operations is responsible for establishing operational objectives, work plans, and delegating assignments to subordinate managers and individual contributors responsible for managing the day-to-day functions of the Strategic Operations team. The Sr. Manager is also responsible for leading Strategic Initiatives and Business Transformation efforts in support of our pre-eminent Provider Delivery System.

• Leads annual review of Provider Manual and updates/revisions by collaborating across teams including Delivery System Engagement, Marketing, Legal, and Regulatory to ensure compliance with Healthfirst, state, and federal government requirements
• Leads project management support for projects as assigned by Sr Leadership including but not limited to non-standard Provider contract implementation.
• Cultivates and strengthens relationships across the organization.
• Ensures deadlines are met, and reports on team's qualitative and quantitative statistics to Executive Management and other key stakeholders.
• Makes recommendations on strategy and process improvement to drive successful outcomes for workflows, processes and projects assigned.
• Leads and when applicable, manages overall productivity of Strategic Operations Teams, including establishing goals and providing direction to subordinate managers.
• Participates as department representative on internal/external audits, including state compliance audits in collaboration with Regulatory.
• Conduct monthly presentations on the unit’s performance and results.
• Responds to questions from Managers/Supervisors staff regarding assigned tasks, acts as liaison to other departments and is empowered to make policy decisions accordingly.
• Communicates decisions/rules to Managers/Supervisors in a clear and effective manner and ensures that the communication is passed along to the entire team.
• Attends meetings as team representative, provides updates, brings back, and shares relevant information.
• Hires, mentors, and coaches’ staff. Handles HR matters. Works with Quality Improvement and Training Specialists to ensure training materials and business requirements are accurate and appropriate.
• Participates as department representative on internal/external audits, including state compliance audits in collaboration with Regulatory.
• Works with internal business partners as needed to ensure successful roll out /completion of assigned initiatives/projects/deliverables (Regulatory, Product, Marketing, Compliance, Clinical Partnership, Population Health, Clinical Quality, etc.)
• Takes the lead and coordinating draft provider communications to ensure proper role out of initiatives to provider community; Works with Marketing to facilitate, create and roll out.
• Serves as a SME within DSE for initiatives assigned within DSE core areas (Hospital, Community, Ancillary, Behavioral Health, Vendor Management) that require additional support.
• Partners with the Director of Strategic Operations to implement reporting and inventory trends
• Additional duties as assigned.

Minimum Qualifications:

• Moderate experience and comprehension of multiple reimbursement methodologies including but not limited to DRG, Exempt Units, RBRVS, APCs, & APGs.
• Experience reading and interpreting data, identifying trends, recommending proactive solutions, and effectively communicating them to senior management.
• Moderate experience working with MS Office Suite to including creating PowerPoint Presentations and data reports in MS Excel, writing formulas, and displaying graphical trends as well as using MS Word to compose letters/memos and execute a mail merge.
• Experience evaluating risk, paying close attention to details and thinking critically in order to make sound business decisions.
• solving problems quickly and effectively.
• Experience in an Operations area, managing repetitive, back-office processes, in a high-volume, quality driven environment.
• Experience dynamically adjusting day to day operations and effectively leveraging resources to accommodate unexpected, time sensitive tasks.
• Previous experience managing change.
• Bachelor’s Degree from an accredited institution or equivalent experience.

Preferred Qualifications:

• 3 or more years of experience in a Leadership role within Managed Care Operations working with various business and cross functional teams to resolve Legal, Regulatory, Compliance, and Quality tasks including root cause analysis, corrective actions plans, and implementation of process improvements.
• 5 or more years of strategic planning and/or project planning including a progression from small, less complex tasks to larger initiatives, with increasing complexity and responsibility