Director - Health Plan Operations, USFHP

Overview:

The operations director provides leadership for USFHP operations: including claims, member services, enrollment, reporting/analytics and marketing.  In collaboration with the Executive Director, develops and implements policies and procedures, staff training materials, and process protocols.  Oversight for ensuring compliance with all Department of Defense contract and policy requirements.  Responsible for operational budget monitoring.  Directly responsible for member satisfaction and develops and implements programs to improve results.  Serves on the national USFHP Alliance Operations Committee as the principal PMC representative.  Responsible for developing and ensuring regular reporting and analysis of data to support the functions of the entire division.  Provides reports and analysis to the USFHP Quality and Patient Safety Committee and the Quality and Patient Experience Committee of the Community Board of Directors.  Serves as the principal internal manager for the MCA module of Athena GE-Centricity.  Promotes service excellence and fosters teamwork, manages the leads of the departments to ensure adequate resources in each, including setting expectations for cross training.

Essential Functions:

Responsible for managing the departments outlined above that is responsible for the provision of services under the USFHP contract with the Department of Defense.

• Develops the departmental budget and is responsible for adherence to budget, including maintaining records and systems to track performance.
  Responsible for assuring compliance with Department of Defense policies and contract regulations.
• Acts as the principle contact for security issues with the federal government.
• Manages the integrity program and appeals process, including ongoing evaluation of the staff who research and prepare appeals for presentation. Decision maker for all post service, network and benefit appeals. Acts as second level manager for grievances. Works with patients and or vendor to reach resolution. Refers those cases that require additional attention to the Executive Director.
• Maintains monthly reports that give clear, measurable information to the executive team and Quality Committee.
• Actively solicits customer feedback on performance of assigned departments; resolves customer complaints, refers unresolved complaints onto the Executive Director as needed.
• Manages the orientation and training and ongoing performance feedback of staff; complete yearly performance appraisals on each employee and interim updates as needed/required.
• Participates in the planning of ongoing staff development programs focused on improving the quality of the services delivered in the department.
• Manages the appeals process, including ongoing evaluation of staff who research and prepare appeals for presentation. Decision maker for all post-services, network and benefit appeals. Acts as second-level manager for grievances. Works with patients or vendors to reach resolution. Refers those cases that require additional attention to the Executive Director.

Qualification & Experience:

• Bachelor's degree in Healthcare Administration or Business Administration – Preferred
• Four years of experience in a healthcare business office or member services experience with progressive responsibilities – Required
• Three years of experience in a managerial role within Pacific Medical Centers or a commercial managed care plan – Required

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.