Business Systems Operations Manager

Job Description:

Select Health is a community health plan serving over 1 million members across Medicare, Medicaid, FEHB, Marketplace Qualified Health Plans, and both fully funded and self-funded Commercial plans.

The Business Systems Operations Manager in the Healthy Connections department leads a team supporting care management and utilization review clinical staff. This role is responsible for overseeing business systems, projects, and program operations, with a focus on planning, coordination, and performance optimization. The manager supervises clinical and nurse informaticists, business analysts, and operational staff, ensuring system efficiency, vendor management, and project execution. This position reports to the Director of Clinical and Business Operations.

Position Details

This role will work Monday-Friday during regular business hours. Candidates located near Intermountain facilities are preferred as on-site presence may be required.

Essential Functions

• Manages various roles including program managers, project / business analysts and clinical informaticists who are responsible for ensuring the information systems, platforms and any vended IS solutions, operational items, projects, etc. meets the department’s business needs.
• Coordinates with other departments and supports implementation of department-specific operational workflows and IS system changes for new products, benefits, geographic expansions, vendors or CMO strategic initiatives.
• Owns prior authorization efforts across Select Health and supports QA efforts along with the solutioning of issues with other departments.
• Oversees project efforts for both the Medical Director and Healthy Connections departments.  Ensures that the resource availability is properly vetted for both internal projects and those of enterprise-level strategic initiatives.  Projects project management resources to both departments, as needed.
• Ensures care management and utilization management system integrity, coordinates system changes, and upgrades system for improvements and verifies that all system change requests meet the applicable regulatory standards (NCQA, CMS, State EQRO, etc.)
• Works with the Project Management Office to establish better communication, resolve complex resource issues, and communicate risks of strategic implementations.   Recommends, develops, and implements innovative strategies for the evaluation of vendors and post-implementation management. Helps oversee the evaluation, analysis, and operational impacts of implementing new vendors across multiple departments. Oversees the evaluation, analysis, and operational impacts of implementing new vendors across multiple departments.
• Manages the department’s escalation processes. Coordinates regularly with other departments to solicit feedback on operational fluidity of systems/processes, to drive process improvement, and build out cross-functional solutions.
• Oversees the technical support request process for end users and providers in relation to the care management and utilization review systems.
• Collaborates to account for any system changes which would impact regulatory reporting data tables. Oversees the prioritization of all reports and ensures the business receives proper support from analytics teams.
• Actively participates in strategic decisions for supported IS systems on behalf of the department.

Skills

• Leadership
• Analytics
• Communication
• Knowledge of information and business systems and platforms
• Project management
• Problem-solving
• Workflow optimization

Minimum Qualifications

• Demonstrated experience and expertise working in a Project Management role.
• Experience in a management / supervisory position working with the administration of managed care products.
• Knowledge of state and federal regulations, statutes, laws, HIPAA, NCQA and contractual requirements related to managed care.

Preferred Qualifications

• Bachelor's Degree in a Business or Health Care related field through an accredited institution.
• Experience working in a professional health insurance organization.
• Certification in project management
• Proven experience working within agile project management frameworks and collaborating with agile teams.
• Solid understanding of Health Information Systems and their operational context.
• Prior leadership experience with a track record of delivering measurable results.
• Familiarity with core project management terminology, methodologies, and best practices.
• Intuitive leader with a proven ability to build and maintain effective professional re