Chief Operating Officer - Health Plan Experience

MetroPlusHealth; New York (NY); On-site; USD 350,000 - 650,000; Full time

Job summary

MetroPlusHealth in New York is seeking a Chief Operating Officer to provide leadership for operational systems, member services, facilities, and claims management, with accountability for Medicaid operations. The COO will drive efficiency, quality, and financial strength while upholding the plan's mission.

The role partners with the Executive Staff and the Board to steer growth, improve member experience, and foster a culture of excellence across all operational lines in a dynamic healthcare

Qualifications

• Bachelor’s degree in a related field is required.
• Master’s in business, healthcare or public administration strongly preferred.
• At least 10 years of senior/executive level experience in the healthcare field.
• 5+ years at VP/SVP/EVP level or higher in a Managed Care Organization in an operational role.
• Experience managing teams of 50+ members.
• Experience and knowledge related to customer experience and service.
• Thorough knowledge of management principles and practices, including process and quality improvement methods.
• Broad and deep knowledge of managed care operations and related technologies.
• Demonstrated knowledge overseeing a diverse array of managed care product lines, claims processing and call center operations.
• Experience with Project Management tools to improve offerings and services.
• Strong IT and finance background a plus.

Responsibilities

• Provide day-to-day leadership across facilities, member services, and claims operations.
• Develop and implement operational systems, controls, and reporting.
• Ensure effective execution of strategic priorities and transformation initiatives.
• Collaborate to establish direction and alliances for strategic results.
• Maintain high level of member experience through call center oversight.
• Oversee billing, claims processing, and operational infrastructure for growth.
• Mentor, coach, and develop staff while upholding MetroPlusHealth culture.
• Represent MetroPlusHealth with external groups and committees.
• Drive improvements in information systems and interdepartmental collaboration.
• Lead governance, policy formation, and strategic planning activities.

Education

Bachelor's degree

Master's degree preferred

Job description

Empower. Unite. Care.

MetroPlus

Position Overview

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. Reporting to the President & Chief Executive Officer, the Chief Operating Officer (COO) provides the leadership, management, and vision necessary to ensure that MetroPlusHealth has the proper operational systems and controls, administrative and reporting procedures, and people systems to effectively operate the Plan while ensuring financial strength and operational efficiency. The COO provides overall management and oversight for product lines of business, member services (including call center operations), facilities, and claims management. In addition, the COO is directly responsible for management of the Medicaid line of business. The COO is a collaborator, interfacing and supporting ongoing relationships with H+H and other partners, representing MetroPlusHealth’s culture and values. The broad and diverse span of responsibilities reporting to this position makes the COO accountable for achievement of key corporate goals and objectives, thus contributing significantly to fulfillment of the Plan’s mission and vision. As a member of the Executive Staff, this position is also expected to provide leadership and vision for the Plan and to provide direction to corporate-wide strategic and business planning, priority-setting, and decision-making.

Scope Of Role & Responsibilities

• Recognizes, adopts, and implements operational best practices and metrics to obtain desired strategic and tactical results.
• Provides day-to-day leadership, directing, aligning and overseeing the staff who manage and operate the organization's core business processes that effect facilities, and MetroPlusHealth staff, ensuring a desired organizational culture while fulfilling the mission and core values of MetroPlusHealth.
• Responsible for the effectiveness and measurement of internal and external operations processes and outcomes, ensuring timely reporting.
• Ensures the effective execution of operational implementations for major strategic priorities, clinical and/or operational transformation initiatives, oversee the operating structure to ensure both efficient and cost-effective contributions at every stage of the healthcare management process.
• Implements new initiatives, resolving problems that cross multiple departments, reducing the impact of faulty processes, workflows and automation that could negatively impact providers and members.
• Collaborates internally and externally to establish direction and enhance alliances to accomplish strategic results.
• Ensures the highest level of member experience through call center oversight and development, implementation and measured success of policies, programs, and practices in the organization.
• Ensures effective, efficient, accurate and timely claims processing.
• Collaborates with the Executive team to develop and implement plans for the operational infrastructure of systems, processes, and personnel which accommodate the aggressive growth objectives of MetroPlusHealth.
• Responsible for facility operations.
• Serves as a member of the Executive Staff, sharing responsibility for and contributing to policy formation, strategic direction, high-level priority setting and decision-making, and overall leadership of the organization. In this capacity provides information, support, and advice to the governing Board of Directors, as requested.
• Mentors, coaches, and motivates others while inspiring them to develop the skills and knowledge to succeed.
• Fosters and upholds a success oriented, accountable, customer focused environment within MetroPlusHealth.
• Performs other tasks as necessary, including representing MetroPlusHealth on appropriate local, state, and national trade groups, governmental and industry workgroups and committees, and similar external venues.

Required Education, Training & Professional Experience

• Bachelor's degree from an accredited college or university in an appropriate discipline required.
• Master's degree in business, healthcare or public administration is strongly preferred.
• Minimum 10 years of senior/executive level experience in the healthcare field.
• Minimum 5+years at a VP/SVP/EVP level or higher in a Managed Care Organization in an operational role required.
• Experience managing teams in excess of 50 team members.
• Experience and knowledge related to customer experience and service.
• Thorough knowledge of management principles and practices, including process and quality improvement methods.
• Broad and deep knowledge of managed care operations, the interconnectivity of diverse and complex functions, managed care information systems and related technologies.
• Demonstrated knowledge and experience overseeing a diverse array of managed care product lines of business, managed care claims processing and call center operations.
• Experience and knowledge in the use of Project Management tools to improve and expand the offerings and services provided by MetroPlusHealth.
• Strong background in IT and finance a plus.

Licensure And/or Certification Required

• Certification in process improvement methodologies strongly preferred.

Professional Competencies

• Comprehensive understanding of the principles and practices of managing information systems and services, and a thorough understanding of how operating areas and information services work together to improve current and future results.
• Strong qualitative, quantitative and analytical skills, demonstrated by ability to identify and use information and data to set goals and priorities, make decisions and measure performance, while considering competing priorities and other perspectives within and outside the organization.
• Excellent writing and verbal communications skills, characterized by the ability to clearly articulate complex concepts.
• Creativity and resourcefulness demonstrated by ability to a) conceptualize and implement new policies, programs and procedures; b) set priorities for self and others; and c) achieve maximum functioning with available resources.
• Ability to balance day-to-day operational issues and needs with corporate issues and needs.
• Good judgment in a) seeking and using information to support decision-making; b) anticipating the consequences of decisions and actions; c) communicating information; d) interacting constructively with others both within and outside the organization; e) maintaining confidentiality, as appropriate; and f) choosing actions that are beneficial to, and consistent with, the mission, goals, culture and style of the organization.
• Ability to take initiative, think independently, and contribute constructively to strategic planning, priority setting and decision-making.
• Must demonstrate a high degree of integrity, trustworthiness, respect for others, and ability to deal appropriately with confidential and sensitive information.
• Must demonstrate understanding and acceptance of the MetroPlusHealth mission vision and values.

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