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WellCare - Operations Leadership Careers

Collaborative Health Systems Operations - Senior Director Job

Full Job Title: Sr Director, Collaborative Health Systems Operations

Job Number: 1804323

Location: Tampa, FL

Date Posted: 2018-06-15

Department: Operations

Reports to: EVP Medicare and Operations

Location: 8735 Henderson Road, Tampa FL 33634

The Sr. Director, Collaborative Health Systems Operations leads and continually improves several functions of the CHS business: operational strategic planning, performance auditing, integration and leveraging of CHS/WellCare capabilities, business analysis, vendor relationship management, project management, as well as systems analysis, design, and implementation. The incumbent performs analytics on operational, quality and financial data to provide guidance on strategic and tactical initiatives to CHS Leadership, and acts as the President CHS' liaison to other corporate Vice Presidents, Directors, and market staff. The incumbent will oversee and continually improve all operational processes and technical infrastructure across the CHS business while supporting and driving a consistent, efficient set of operating models across the CHS business. Responsible for leading year-round collection of quality and risk adjustment performance data, leading to the successful annual submission of data to CMS and successful response to subsequent audit requests from CMS. Ensures that the CHS operations is complying with CMS and partnership agreements.

Essential Functions:
  • Develops operational strategies and solutions to constantly improve the CHS operations/operating models to meet CHS objectives. Directs long term and short term planning including manpower, facility, training, and systems requirements.
  • Sets operational priorities and investments; works with staff that manages resources to optimize structure and achieve operational goals within set budgets.
  • Assists in defining marketing and advertising strategies within State guidelines. Participates in the development and implementation of marketing policies for the ACO, and ensures their compliance with program regulations.
  • Oversee development and maintenance of the “measure matrix” according to periodic updates to ACO quality measures, when external clinical specifications for existing measures are redefined as well as when new measures are added or existing measures are retired from the ACO quality measure set.
  • Oversees process to document and monitor service metrics committed to by each contract and assess how we are performing against those service standards.
  • Support new business development through: statement of work creation, analysis of our ability to achieve standards (based on our past performance, complexity etc.), project management, conduct critical operational meetings, etc.
  • Coordinate audit activities to support readiness reviews for new business or audits of existing partnerships
  • Prioritize and manage projects requiring information systems development, delegation or data extracts for external stakeholders and vendors.
  • Manage and improve externally-facing data communications processes, such as managing providers and ACOs in the Health Professional Management System (HPMS).
  • Document operational processes and infrastructure changes in progress, via policies/procedures and business requirements documents and other tools.
  • Lead implementation and integration efforts for advanced provider partnerships (ACOs, MSOs, etc), including collaboration with Vice Presidents, General Counsel, corporate staff, Director and market staff to ensure timely completion of regulatory, legal, infrastructure and business operations requirements to launch and maintain. Ensure that governance model is appropriate.
  • Develops and directs the implementation of goals and performance standards in each area assigned along with operations and field staff.
  • Train CHS staff and external partners (as applicable) to leverage CHS tools and process management applications to manage ACO administrative requirements.
  • And all other duties assigned by the manager and/or supervisor.
Additional Responsibilities:
    Candidate Education:
    • Required a Bachelor's Degree in Business, Health Management, Information Systems, or related field or equivalent.
    • Preferred a Master's Degree in a related field MBA or MHA
    Candidate Experience:
    • Required 7 years of experience in Experience with a major health plan and/or medical provider with Medicare/Medicaid exposure.
    • Required 5 years of experience in Managing the strategy, implementation, and optimization of systems, software and process management tools.
    • Preferred Other Experience working in an ACO/MSO/IPA organization.
    • Preferred Other Writing provider-facing (e.g., physician, hospital, etc.) communications and provider relations encounters.
    Candidate Skills:
    • Advanced Ability to work independently
    • Advanced Ability to work in a matrixed environment
    • Advanced Ability to work as part of a team
    • Advanced Ability to drive multiple projects
    • Advanced Demonstrated project management skills
    • Advanced Ability to communicate and make recommendations to upper management
    • Advanced Ability to effectively present information and respond to questions from peers and management
    • Advanced Demonstrated problem solving skills
    • Advanced Ability to work within tight timeframes and meet strict deadlines
    • Advanced Demonstrated interpersonal/verbal communication skills
    • Advanced Demonstrated negotiation skills
    • Advanced Demonstrated written communication skills
    • Advanced Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
    • Advanced Other Demonstrated facilitation and presentation skills.
    • Advanced Other Flexibility to adapt to changes in environment, industry and business demands.
    • Advanced Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
    • Advanced Other EMR system experience required.
    Licenses and Certifications:
    A license in one of the following is required:
    • Preferred Project Management Professional (PMP)
    Technical Skills:
    • Required Intermediate Microsoft Visio
    • Required Intermediate Microsoft Project
    • Required Intermediate Microsoft Word
    • Required Intermediate Microsoft Outlook
    • Required Intermediate Microsoft PowerPoint
    • Required Intermediate Microsoft Excel
    • Required Intermediate Adobe Acrobate
    • Required Intermediate A.Net

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      Last Updated On: 12/9/2015