DSNP Operations Manager-Government Programs

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health.  For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience.  Our members are our neighbors, our friends, and our families.  It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. 

This position is responsible for the daily leadership and oversight of non- clinical operations. Ensure enterprise and divisional performance goals are achieved

Job Responsibilities:

• Manages and directs staff to ensure overall client satisfaction, appropriate level of service delivery, quality outcomes.  Staff includes supervisors and non-clinical employees.
• Manages Call Center which includes an 800 phone line and electronic inventory.
• Interfaces with other teams and plan areas to assure consistent application of policies and procedures and to facilitate inter-unit/department projects.
• Creates and champions an atmosphere within the team, which fosters open communication, increase employee engagement, teamwork, ownership, and a collaborative cross-departmental environment to implement, optimize and share continuous improvement processes.
• Manages, directs, and develops staff by providing feedback and coaching. Administers performance and salary reviews for staff. 
•  Identify opportunities and implement process improvements (i.e., root cause analysis, Administer and monitor Service Level Agreements (SLAs) with appropriate business partners.
• Lead or participate in both internal/external workgroups/committees, maintain internal/external business partnerships and represent department/enterprise where appropriate
• Perform other related tasks as assigned or required by operational need
• Accountable for maintaining effective internal controls over the processes and transactions under areas of responsibility including the completeness and accuracy of financial information and transactions, compliance with applicable laws and regulations, and the effectiveness and efficiency of operations.

Addendum- Reconciliation & Enrollment:

• Responsible for leading the MA/Braven, PDP and DSNP teams on all upfront enrollment functions along with ensuring accurate and timely completion of all internal and CMS/ State reconciliation related items.
• Ensure both enrollment and reconciliation units meet the regulatory compliance requirements set by internal and external entities ( i.e GP regulatory compliance, CMS , State)
• Oversee and participate all internal and external MA/Braven, PDP and DSNP related audits and review /monitor all related control and quality reports to ensure completion as defined in the related guidelines.
• Identify and implement efficiencies to improve overall  MA/Braven, PDP and DSNP enrollment and reconciliation operations units.
• Lead and participate in both internal/external MA/Braven, PDP and DSNP workgroups/committees, maintain internal/external business partnerships and represent department/enterprise where appropriate.

Education/Experience:

• Bachelor's Degree preferred or relevant work experience required in lieu of degree.
• 3 years of supervisory experience required.
• 5 years of operations experience required.

Specialized knowledge/skills:

• Healthcare Industry, Technology, Business Management, Microsoft Office, Call Center experience

Additional Skills:

• Experience managing high volume call center preferred.
• Interpersonal, Negotiation, Leadership & Coaching, Analytical, Problem-Solving. skills.

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range:

$96,300 - $131,565

​This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.  This range has been created in good faith based on information known to Horizon at the time of posting.  Compensation decisions are dependent on the circumstances of each case. Horizon also provides a com