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Chief Operating Officer (DC Medicaid)

Washington, DC, USA | CareFirst

  • Industry:
    Healthcare - Hospitals
  • Position Type:
  • Functions:
    General Management
    Strategy
  • Experience:
    3-5 years
    5-7 years
    7-10 years
Job Description:
54 people have viewed this job

The Chief Operating Officer (Community Health Plan - DC Mediciad) is responsible for management and administration of multiple functions and general business operations, claims, information system conversions, call center performance guarantees, state reporting, provider network strategy, and appeals & grievances. This role provides subject matter expertise in project management, project scope definition, risk identification, project methodology, resource allocation and other areas of expertise. The Chief Operating Officer is also responsible for provider value-based contract oversight, meeting with providers individually as well as joint operating committees; relationship management (behavioral health, Rx, payment integrity, dental, vision, analytics); and the design, coordination and completion of operational improvement projects across various functional areas, will review the various departments’ performance and effect change as needed to improve service, simplify work flow and assure compliance with regulatory requirements.


 


POSITION DUTIES AND RESPONSIBILITIES


• Plans/implements and manages operations programs and strategies


• Supports, develops and validates compliance with operations policies, procedures and regulations


• Reviews, manages and drives operations efficiency, quality and financial performance


• Sets business direction, develops, implements and oversees operational models to meet the unique needs and business requirements


• Verifies improvements and operations are evaluated based upon appropriate quantitative and qualitative measures


• Develops collaborative relationships with and confirms business partners can execute day-to-day responsibility for operations (member services center, enrollment, technology, network, etc.)


• Informs and advises management regarding Commonwealth current trends, problems and activities to facilitate both short- and long-range strategic plans to improve operational performance and enhance growth


• Confirms all operational activities conform to contract compliance for all programs


• Sets business direction, develops, implements and oversees operational models to meet the unique needs and business requirements for THP


• Confirms operations and service models are optimized


• Develops collaborative relationships with and confirms business partners can execute day-to-day responsibility for operations (member services center, enrollment, technology, etc.)


• Develops collaborative relationships across multiple service offerings


• Informs and advises management regarding State’s current trends, problems and activities to facilitate both short- and long-range strategic plans to improve operational performance and enhance growth


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


• Owns accountability for state reporting metrics, accuracy, and timeliness


• Identifies and resolves technical, operational and organizational problems inside and outside health plan


• Understands and manages the State requirements and relationship related to operations


• Provides governance on network strategy and development


• Directs others to resolve business problems that affect multiple functions or disciplines


 


QUALIFICATIONS


• Bachelor’s degree in Healthcare Administration, Business, or Management, MBA preferred NCQA experience


• Three years working in a matrix organization


• Knowledge of and experience related to publicly funded government health care programs (e.g., Medicaid, Medicare or State health care programs for the uninsured)


• Technical and financial understanding of health care operations


• Ability to advise IT resources related to enterprise platform initiatives; provides direction on platform migration


• Experience, aptitude, and effectiveness in matrix environment


• Working knowledge of relevant federal and state regulations and requirements


• In depth understanding of challenges that face health plans and health care in general


• Seven years of people management experience required Knowledge of and experience related to publicly funded government health care programs (e.g., Medicaid, Medicare or Commonwealth health care programs for the uninsured


• Operations experience in Medicaid/Medicare/government health care program administration


• Strong leadership and business planning skills within a matrix environment


• Ability to communicate clearly with internal partners and external regulatory agencies


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