Virginia Premier Health Plan, Inc.

Have you applied with us before?

Director of Health Services Operations

Director of Health Services Operations

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4384

Job Description

Overview

The position works with the VP, Operations and other department leaders to identify and implement Health Plan initiatives that impact operational efficiency, drive short and long range goals, enhances business development efforts and a continued focus on optimization of the clinical and non-clinical areas of medical management to include quality and reporting. May participate in projects, such as implementation of new product lines or technology solutions. Also responsible for creating a strategic vision, processes, tools and procedures to assure ongoing visibility to operational performance of the department and company.

Responsibilities

  • Works closely with all units within medical management (multiple locations) and Information Systems, serving as the primary contact to ensure appropriate key operational indicators are in place for monitoring and analysis.
  • Coordinates and facilitates cross-functional issue resolution sessions emphasizing issue identification, root cause analysis, and eradication to improve clinical outcomes.
  • Provide leadership on various corporate committees and enterprise-wide projects affecting clinical and non-clinical staff, such as, but not limited to, major system initiatives.
  • Ensure all programs and processes meet requirements of CMS regulations and URAC and/or NCQA standards and required quality improvement activities.
  • Establish, monitor and achieve operational performance metric targets in collaboration with medical management leaders, including medical directors, pharmacy directors and external vendors.
  • Partners with analytics team to develop to develop reporting tools to evaluate and develop actionable reports to communicate with internal and external partners regarding risk assessments and cost efficiency opportunities.
  • Collaborates closely with all internal program leaders and line of business owners to understand specific population performance and member needs to define strategy, care improvement opportunities and improve service operations.
  • Identifies internal deficiencies with data, challenges medical management teams to improve on measurement and analysis to drive informed operation decisions.
  • Manages relationships and special projects with external vendors by identifying opportunities based on scalability, affordability and business needs.
  • Assists all medical management operational areas in establishing processes, standards, measures and documentation of SOPs, process maps and staff training to ensure optimal performance.
  • Any other duties as assigned

Qualifications

MINIMUM EDUCATION REQUIRED

  • BS Degree in Business, Healthcare Administration or related field of study. (Masters preferred) 

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Excellent verbal and written communication skills
  • Health plan operations, implementation and program management experience
  • Acumen in research and evaluation; proven ability to use data to identify trends, gain insights and drive change
  • Knowledge of NCQA and CMS Regulations
  • Proficient Microsoft Office computer skills including Project Management

 

WORK BACKGROUND/EXPERIENCE  

  • Minimum of five (5) years’ experience in a related field, with 5-7 years of operations’ management experience
  • Minimum of five (5) years Program/Project Management experience
  • Business analysis and process improvement experience
  • Clinical license highly desireable

 

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position.

 

About Us

Virginia Premier is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

 

Need help finding the right job?

We can recommend jobs specifically for you! Click here to get started.