Healthcare Core Ops Lead | Systems & Process Improvement

MetroPlusHealth; New York (NY); On-site; USD 110,000 - 150,000; Full time

Job summary

MetroPlusHealth in New York is seeking a Core Operations Manager to evaluate and improve Core Systems and Applications. You will work with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to ensure system capabilities meet department and business needs.

You will track performance, manage initiatives, and coordinate with internal and external stakeholders using Jira and ServiceNow, ensuring SLAs are met and improvements are implemented.

Qualifications

• Bachelor’s degree required in IS/MIS, CS or related field.
• 5–7 years of experience in healthcare systems, especially payer systems such as claims processing and benefit configuration.
• Project Management and Staff Supervision experience is a plus.

Responsibilities

• Track and advise on Core systems performance and vendor issues.
• Manage and support business initiatives related to Core systems.
• Ensure initiatives stay on track using Jira and ServiceNow.
• Review SLA performance and escalate concerns to leadership or vendor teams.
• Direct communications between business units and Core system vendors on shared objectives.
• Collaborate with Claims Operations, Utilization Management, and Network Management to understand system use cases.

Skills

Project management

Staff supervision

Stakeholder communication

Process improvement

Education

Bachelor's degree in Information Systems/MIS, Computer Science or Software Engineering, Health Information Management, or Business Administration

Job description

MetroPlusHealth in New York is seeking a Core Operations Manager to evaluate and improve Core Systems and Applications. You will work with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to ensure system capabilities meet department and business needs.

You will track performance, manage initiatives, and coordinate with internal and external stakeholders using Jira and ServiceNow, ensuring SLAs are met and improvements are implemented.