Director, HealthPlan Operations at Commonwealth Care Alliance in Boston, Massachusetts

Posted in Other 3 days ago.





Job Description:




Why This Role is Important to Us
The Director of Health Plan Operations is a highly functioning leader on the Health Plan Operations team and is responsible for providing strategic leadership, guidance and tactical direction. Responsible for managing its resources, developing and implementing an operational plan and ensuring that procedures are carried out properly. Regularly evaluates organizational efficiency and makes necessary changes to maximize staff producitivity. Assess the needs of the company and find ways to contribute to the company's vision by ensuring daily operations run smoothly and as efficiently as possible.This position is responsible for leading cost effective, high quality, compliant operations, combining disciplined business process and information technology that delivers value to its' stakeholders.

What We're Looking For


  • Bachelor's degree in business, finance, healthcare or a related field or equivalent experience.

  • A minimum of 10-15 years healthcare delivery experience.

  • Master's degree Preferred

  • Professional certifications in personnel management, operations management, and/or data analysis will be very useful.

  • 10 -15 years experience in healthcare delivery.

  • 5 years experience in a management or leadership capacity.

  • Minimum 3-5 years experience leading a complex healthcare operations environment including leading operational improvement.

  • Excellent vendor management experience including RFI and RFP process.

  • Excellent leadership and organizational abilities.

  • Superior knowledge of healthcare industry regulations and operational guidelines. Including Provider Network Operations

  • Working knowledge of customer relationsip management (CRM packages)

  • Excellent interpersonal, written and verbal communication skills.

  • Highly organized

  • Innovative and solution oriented

  • Critical thinking skills

  • Experience working with senior-level management

  • Demonstrates success innovating solutions to increase productivity and profitability.

  • Demostrated leadership skills.

  • Expert with Microsoft Office products

  • English



Actual Work Location
2 Avenue de Lafayette, Boston, Massachusetts 02111-1750

All Locations
Lafayette City Center

Exempt / Not Exempt
Exempt




What You'll Be Doing

  • Provides direction and oversight over assigned functions within Claims Operations, Payment Integrity, Provider Data Management and Credentialing, staff, projects and daily operations to achieve the highest levels of performanc

  • Exhibits effective, adaptive leadership style that promotes innovation and establishes work priorities.

  • Uses sound judgement to resolve politically sensitive roadblocks

  • Develops productive and collaborative working relationships with internal and external partners such as third-party vendors for provider data management and claims, customers and suppliers.

  • Inventory management including but not limited to provider data management and credentialing.

  • Develops, monitors and submits regular service quality key indicators for each department to improve business results with overall Operation's quality measures and while adhering to compliance/government requirements (NCQA, CMS, EOHHS and related agencies).

  • Defines, implements and revise operational policies and guidelines for the organization including SOP's and policies and procedures.

  • Translates overall corporate priorities/business strategic initiatives to determine impact and develop and execute operation goals.

  • Well developed planning capabilities with a track record of achieving results, controlling costs, setting budgets and meeting deadlines.

  • Ability to think critically, drive change and influence individuals at all levels of the organization and to take appropriate risks.

  • Liasing with departmental heads to ensure company-wide compliance.

  • Participates in cross functional meetings representing functional needs and concerns as well as leading and involvement in relevant projects.

  • Creates performance excellence by identifying bet practices and improving operational efficiency

  • Formulates and oversees the implementation of corrective action plans resulting in internal and external audit findings and customer concerns.

  • Delegates effectively to develop staff and achieve timely results

  • Consistently demonstrates ability to act and react swiftly to continuous change and challenges

  • Delivers persuasive messages/arguments based on sound, thorough fact-based analysis and logic to compel senior management teams to act as needed.

  • Ensures operational effectiveness of systems, processes, procedures and staffing levels for a high performing and evolving team.

  • Fosters trust with senior leaders, peers and staff

  • Develops staff to ensure succession planning at all levels in the organization

  • Maintains highest personal and professional integrity. Works with HR to create job descriptions and hire competent personnel.