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Director, Medicare %26 Medi-Cal Operations at Blue Shield of CA in El Segundo, California

Posted in Other 30+ days ago.

Type: Full Time





Job Description:

At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. Were excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Areas top companies in volunteering & giving, and one of the worlds most ethical companies. Here at Blue Shield of California, were striving to make a positive change across our industry and the communities we live in Join us!

Reporting to the Head of Customer Care, the role of the Director, Medicare and Medi-Cal Operations is critical to the success of Blue Shield of California and the Customer Experience and Shared Services department in realizing its goals and objectives. This individual will play a key role as part of Customer Care leadership team in delivering and collaborating on all aspects of Medicare and Medi-Cal Operations which supports one of our company's key growth initiatives.

Specifically, the Director, Medicare and Medi-Cal operations role will be accountable for:

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Strategic and Tactical Planning for Medicare and Medi-Cal Call Center Operations including , service delivery including transportation services
*

Develops business strategies for Medicare and Medi-Cal Operations
*

Manages service, regulatory and financial performance of the Medicare and Medi-Cal Operations teams
*

Defines and implements organizational structure to facilitate business performance. Ensure optimization of resources by resolving any duplicative improvement efforts and organization structures
*

Provides executive oversight and leadership to Managers responsible for creating and driving implementation of operating plans, which are required to support immediate and long-term business strategies.
*

Ensure customer-driven Key Performance Indicators(KPIs) and goals are in place, which are reflective of and measure our strategic, competitive and regulatory position with ongoing measurement, reporting, and root cause analysis.
*

Guides and develops near-term operating plans for designated area of responsibility
*

Lead end-to-end process improvements throughout the organization designed to create efficiencies and allow us to scale for growth, such as expanding automation and adoption of self-service portals.
*

Responsible for the interpretation and translation of regulatory and accreditation requirements into operational procedures that support Blue Shield compliance with various state and federal laws and accreditation standards. "
*

Regulatory Audits Provides direction and management for Regulatory (CMS, DHCS), including documentation of evidence supporting compliance, the onsite file review and the interview processes and the written response processes.
*

Cross Enterprise Inquiry Program Drives enterprise-wide program for addressing Executive Level Inquiries on behalf of executive offices
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Medi-Cal and Medicare appeals and grievances is also responsible for maintaining Regulatory Compliance with CMS (Centers Medicare Services) in 10 keys areas, along with managing risk for audits both internal and external.
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Provide thought leadership to the Customer Experience Leadership Team, other cross-functional leaders throughout BSC operational issues.
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Provide effective leadership in attracting and retaining top talent to drive the business results for this business segment.

2020 Goals :

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Membership: Drive and support growth of Medicare and Medi Cal members by meeting customer experience deliverables
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Operating Income: Achieve or exceed the 2020 operating income plan
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Achieve the financial plan by -3% or 3%, while achieving or exceeding service levels : 80% in 30 seconds annually and increasing ASAT to 80% by end of 2020
*

Support the improvement of the Medicare Star rating of 3.8 by leading the Medicare call center to achieve 4.5 rating or higher * Achieve or exceed MTM targets

Reporting to the Head of Customer Care, the role of the Director, Medicare and Medi-Cal Operations is critical to the success of Blue Shield of California and the Customer Experience and Shared Services department in realizing its goals and objectives. This individual will play a key role as part of Customer Care leadership team in delivering and collaborating on all aspects of Medicare and Medi-Cal Operations which supports one of our company's key growth initiatives.

Specifically, the Director, Medicare and Medi-Cal operations role will be accountable for:

*

Strategic and Tactical Planning for Medicare and Medi-Cal Call Center Operations including , service delivery including transportation services
*

Develops business strategies for Medicare and Medi-Cal Operations
*

Manages service, regulatory and financial performance of the Medicare and Medi-Cal Operations teams
*

Defines and implements organizational structure to facilitate business performance. Ensure optimization of resources by resolving any duplicative improvement efforts and organization structures
*

Provides executive oversight and leadership to Managers responsible for creating and driving implementation of operating plans, which are required to support immediate and long-term business strategies.
*

Ensure customer-driven Key Performance Indicators(KPIs) and goals are in place, which are reflective of and measure our strategic, competitive and regulatory position with ongoing measurement, reporting, and root cause analysis.
*

Guides and develops near-term operating plans for designated area of responsibility
*

Lead end-to-end process improvements throughout the organization designed to create efficiencies and allow us to scale for growth, such as expanding automation and adoption of self-service portals.
*

Responsible for the interpretation and translation of regulatory and accreditation requirements into operational procedures that support Blue Shield compliance with various state and federal laws and accreditation standards. "
*

Regulatory Audits Provides direction and management for Regulatory (CMS, DHCS), including documentation of evidence supporting compliance, the onsite file review and the interview processes and the written response processes.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.