CareNational Hiring for VP – IPA Operations Job at Remote Full Time

JOB SUMMARY:
Develops and leads company’s operational policies, objectives, and initiatives to support ongoing national growth for all product lines (including Medicare, Medicaid, Commercial, Exchange), risk models (value-based care, professional risk, global risk) and delegation levels. Creates and executes strategies to attain short- and long-term financial and mission-critical operational goals, while ensuring compliance with federal, state and health plan regulations/policies. Utilization of continuous process improvement techniques and technology solutions will be key to successfully delivering on quality and productivity goals.
DUTIES:

• Provides leadership and direction for key operations departments & functions, to include Claims Payment; System Configuration for contracts/benefits/DOFRs; Encounter Data; Customer Service; Credentialing and Provider Data Management.
• Ensures department & staff goals are established & monitored to drive company goal achievement annually. Includes oversight of external vendors, as well as internal staff. Presents periodic performance reports and metrics to the chief operating officer and other leadership.
• Maintains working knowledge of healthcare regulations and health plan policies to ensure compliance for all lines of business (Medicare, Medicaid, Commercial, Exchange) and in all operating states. Monitors regulatory and health plan audit results to identify and address any adverse trends. In addition, establishes and monitors internal quality assurance audit processes as a part of continued operational improvements.
• Provides leadership, mentoring and management to departments to ensure adequate, ongoing training & quality assurance; goal attainment; and ongoing elevation of individual skill sets. Ensures teams’ compliance with regulatory, health plan and company policies & procedures and strategic use of tools and reports. Develops metrics and tools to measure/affect progress on company, team, and individual goals, monitoring & implementing new/revised action plans as warranted. Includes management to budget.
• Collaborates with Executive Team and key business units to identify, evaluate and implement data automation and process improvements.
• Supplies operational expertise and guidance on potential acquisitions, projects, and systems.
• Collaborates with other divisions and departments to carry out the organization’s goals and objectives.

REQUIRED EDUCATION/EXPERIENCE:
Bachelor’s degree in Business Administration, Healthcare Management or another industry-related field required.
At least 10 years of industry-related experience including three years in upper management required.
PREFERRED EDUCATION/EXPERIENCE:
MBA preferred.