Assistant Vice President - Health Plan Operations - Jackson, Mississippi United States - 21092

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JOB DESCRIPTION

Job #: 21092
Title: Assistant Vice President - Health Plan Operations
Job Location: Jackson, Mississippi - United States
Employment Type:
Salary: $130,000.00 - $175,000.00 - US Dollars - Yearly
Employer Will Recruit From: Nationwide
USA
Relocation Paid?: Negotiable

WHY IS THIS A GREAT OPPORTUNITY?


Join one of the largest managed care organizations that manage government business in serving Medicaid and Medicare populations.

This is a new and highly visible opportunity to oversee the development and administration of State Health Plan's operational departments, programs and services.

JOB DESCRIPTION

Policy Management:

Directly manages the Plan's benefit configuration, claim payment policies and the maintenance or modification of such, to support accurate and timely claims payment. In addition, manages the Plan's Provider Configuration/Information activities to ensure compliance with regulatory requirements and accurate claims and encounter submissions.

 

Compliance:

Accountable for ensuring Health Plan Operating metrics consistently meet and/or exceed all compliance requirements as well as key performance targets and associated service level agreements.

Serves as liaison with Enrollment and Contact Center Operation leaders to ensure full and consistent compliance with Health Plan state contract and regulatory requirements. Works collaboratively with corporate business owners to mitigate risk related to enrollment processes and call center performance.
Directs analytical activities to identify trends and potential opportunities with those Corporate Operations functions that may impact the functionality of Health Plan Operations.

Serves as liaison with Enrollment and Contact Center Operation leaders to ensure full and consistent compliance with Health Plan state contract and regulatory requirements. Works collaboratively with corporate business owners to mitigate risk related to enrollment processes and call center performance.

Process Improvements:

Works with staff and senior management to develop and implement improvements and oversight for non-clinical Health Plan operations.

Serves as the Senior Plan leader and liaison for the Service Operations, including: Claims, Configuration Information Management, Enrollment, Contact Center Operations, IT, Provider Configuration Management, Program Integrity, Risk Adjustment, Provider Resolution Team, Provider Appeal and Grievances, Member Appeals and Grievances, and other departments as required.

 

QUALIFICATIONS

  • Bachelor's Degree in Business, Health Services Administration or related field, or comparable experience.
  • Master's Degree in Business, Health Administration or related field.
    • 7-10 years' experience in Healthcare Administration, Health Plan Operations, Managed Care, and/or Provider Services.
    • Experience managing/supervising employees.
    • Expertise with Medicaid and Managed Care. - plans, organizes, staffs, and coordinates the operations of state Medicaid/CHIP, Medicare and Marketplace Health Plan operations
  •  Experience working in Matrix environment.

Reporting into the Plan President, this role requires the identification and adoption of best practices from across the enterprise for Health Plan and MHI Service Operations; developing strategies and tactics in partnership with MHI Service Operations to mitigate any issues or performance levels not meeting established service levels and provides corporate oversight including the efficacy of vendor management.

The ideal candidate will directly manage the Project Management and Process Improvement teams and resources for the plan.

Second in command to manage all operations.

Education:
University - Master's Degree