Senior Manager, Operations G & A

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive.  This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on 5 Core Values in the workplace:

•    Integrity

•    Accountability

•    Collaboration

•    Trust 

•    Respect

Disclaimers:

•    Flexible work schedule is based on job duties, department, organization, or business need.

•    Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

The Senior Manager, Operations G & A is responsible for overseeing the day-to-day operational functions. The Senior Manager, Operations G & A will need to ensure compliance with regulatory requirements, efficient processes, and high-quality service delivery to members and providers.  The leader will direct and coordinate cross-functional teams, including Eligibility & Enrollment, Grievance & Appeals, and other operational support areas. 

Amount of Travel Required: 10%-30%

Work Schedule: Travel to multiple sites and locations. Work protracted and irregular hours and evening meetings or work irregular hours for attendance at meetings for special projects and programs.

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statements

•    Ensure effective and efficient operational processes and regulation adherence including validation that all new policies and procedures are implemented

•    Provide leadership and operational oversight of core functions such as Enrollment & Eligibility, Claims Operations, Appeals & Grievances, and other vendor-supported services. 

•    Lead, coordinate and complete operational improvement projects across various functional areas within and outside of Gold Coast Health Plan

•    Own end-to-end process improvement: including definition of need, project plans, status updates, reporting and achieving results

•    Establish operating metrics and daily, weekly, and monthly scorecards to manage ongoing operations 

•    Enhance the operational procedures, systems, and principles in the areas of information flow and management, business processes, enhanced management reporting and identification of process improvements 

•    Collaborate with departments including Compliance, Quality, Finance, Clinical and IT to support enterprise-wide initiatives and projects

•    Represent the operations department in cross-departmental meetings and planning activities.

•    Lead and support implementation of new programs, systems, or regulatory changes.     

•    Carry out supervisory responsibilities in accordance with company's policies and regulatory requirements

•    Inform and advise management regarding California Department of Health Care Services’ current trends, problems and activities to facilitate both short- and long-range strategic plans to improve operational performance

•    Direct responsibility of oversight within the Grievance and Appeals department and the Operations Governance work activities to ensure the contractual service and regulatory standards are met and ensure adherence to established policies and procedures regarding appeals and grievances process for both members and providers and adherence to the agreements that exist for delegated entities 

•    Work closely with Gold Coast Health Plan’s (GCHP) Medical Director and Health Services staff in resolving a