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Corporate Functions & Operations WellCare - Operations Leadership Careers

Encounters - Director Job

Full Job Title: Director, Encounters

Job Number: 1701739

Location: New York, NY

Date Posted: 4-17-2017

Responsible for business portfolio management, data management development, encounters submissions, and encounter reporting for one or more WellCare business areas. Supported business areas may include core processing (claims, enrollment, and provider and member data management); channel services (contact center, and workflow); health services (care and disease management); enterprise data management (data warehouse, reporting, and health quality measures). Primary responsibilities include developing annual plan aligned to business needs, responding to new regulatory requirements, specifying systems supporting value-driven business initiatives; implementing process improvement, enhancements governed by business prioritization committees; coordinate key activities regarding the informatics strategy. Implement costs savings initiatives. Works closely with business partners, IT, Compliance, and Internal Audit.

Department:Executive - Operations

Reports to:VP, State Operations

Location: Manhattan, NY



Essential Functions:

  • Responsible for Encounters submissions; ensuring they meet required regulatory and business requirements within acceptable timeframes.
  • Manages and develops direct reports who include managers and senior managers.
  • Annually and throughout the year, works with business partners to align business and Informatics strategies, and establish and maintain a project portfolio.
  • Manages relationships with business leaders ranging from manager to VP.
  • Sets overall goals, performance standards, and operational priorities for one or more functions and manages resources to operational and financial goals.
  • Builds and manages a team of senior managers, managers, other associates, and contractors responsible for the maintenance, support, and development of systems within span of control.
  • Drives project estimations, feasibility assessments, prioritization, and resource management activities.
  • With approval of Senior VP or other member of executive management establishes and monitors budget within span of control.
  • Works with VPs and Senior Directors to establish and maintain vendor relationships.
  • Collaborates with business partners in the management of vendor relationships which include information technology.
  • Works closely with the PCO's and Informatics team to meet all regulatory and business requirements regarding encounter submissions.
  • Implements WellCare's data management strategy and data governance standards.
  • Works with IT Compliance, WellCare Compliance, and Internal Audit to adhere to all policies and to support audit requirements.
  • Works with all business units to improve and enhance data management practices.
  • Coordinates business dependencies associated with data management initiatives (i.e. Internal Action Plans)
  • Manages communications to executive leadership of current processes.
  • Develops executive dashboards to track internal and external accountable owners and partners.
  • Leads strategic initiatives to optimize Encounters results.
  • Performs other duties as assigned.

*LI-CW1

Candidate Education:
  • Required A Bachelor's Degree in a related field
  • Required or equivalent work experience
Candidate Experience:
  • Required 3 years of management experience of progressively responsible managerial experience and at least 1 year of managerial experience with similar responsibilities and span of control.
  • Required 7 years of experience in two or more of the following areas with deep subject matter expertise in at least one area: claims, enrollment, and provider and member data management; health services (care and disease management); and enterprise data management (data warehouse, reporting, and health quality measures such as HEDIS).
  • Preferred Other Experience in environments with large, complex, real-time transaction volumes
Candidate Skills:
  • Advanced Demonstrated leadership skills
  • Advanced Demonstrated written communication skills
  • Advanced Demonstrated interpersonal/verbal communication skills
  • Intermediate Ability to analyze information and covert related activities into a comprehensive work plan
  • Intermediate Ability to lead/manage others in a matrixed environment
  • Advanced Other facilitative skills
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft PowerPoint
  • Required Intermediate Microsoft Project
  • Preferred Intermediate Other • Experience with one or more of the following: • Dell-Perot claims processing platform (Diamond, Peradigm, Xcelys); Java (especially J2EE), Microsoft .net, PLSQL, Cognos (or similar data reporting and analytics tool), Informatica (or similar ETL product), SAS, Database (Oracle, SQL Server, and MySQL preferred), HIPAA X12 EDI Transactions, Edifecs (or similar EDI management product) is desired. • Experience with one or more of the following: • Dell-Perot claims processing platform (Diamond, Peradigm, Xcelys); Java (especially J2EE), Microsoft .net, PLSQL, Cognos (or similar data reporting and analytics tool), Informatica (or similar ETL product), SAS, Database (Oracle, SQL Server, and MySQL preferred), HIPAA X12 EDI Transactions, Edifecs (or similar EDI management product) is desired. • Experience with one or more of the following: • Dell-Perot claims processing platform (Diamond, Peradigm, Xcelys); Java (especially J2EE), Microsoft .net, PLSQL, Cognos (or similar data reporting and analytics tool), Informatica (or similar ETL product), SAS, Database (Oracle, SQL Server, and MySQL preferred), HIPAA X12 EDI Transactions, Edifecs (or similar EDI management product) is desired. • Experience with one or more of the following: • Dell-Perot claims processing platform (Diamond, Peradigm, Xcelys); Java (especially J2EE), Microsoft .net, PLSQL, Cognos (or similar data reporting and analytics tool), Informatica (or similar ETL product), SAS, Database (Oracle, SQL Server, and MySQL preferred), HIPAA X12 EDI Transactions, Edifecs (or similar EDI management product) is desired. • Experience with one or more of the following: • Dell-Perot claims processing platform (Diamond, Peradigm, Xcelys); Java (especially J2EE), Microsoft .net, PLSQL, Cognos (or similar data reporting and analytics tool), Informatica (or similar ETL product), SAS, Database (Oracle, SQL Server, and MySQL preferred), HIPAA X12 EDI Transactions, Edifecs (or similar EDI management product) i• Experience with one or more of the following: • Dell-Perot claims processing platform (Diamond, Peradigm, Xcelys); Java (especially J2EE), Microsoft .net, PLSQL, Cognos (or similar data reporting and analytics tool), Informatica (or similar ETL product), SAS, Database (Oracle, SQL Server, and MySQL preferred), HIPAA X12 EDI Transactions, Edifecs (or similar EDI management product) i• Experience with one or more of the following: Dell-Perot claims processing platform (Diamond, Peradigm, Xcelys); Java (especially J2EE), Microsoft .net, PLSQL, Cognos (or similar data reporting and analytics tool), Informatica (or similar ETL product), SAS, Database (Oracle, SQL Server, and MySQL preferred), HIPAA X12 EDI Transactions, Edifecs (or similar EDI management product).
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Last Updated On: 12/9/2015