Remote Core Operations Manager - Healthcare Systems

MetroPlus; New York (NY); On-site; USD 90,000 - 130,000; Full time

Job summary

MetroPlusHealth is seeking a Core Operations Manager to evaluate and improve core systems and applications. You will partner with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to align systems with department and business needs.

The role requires 5–7 years in healthcare payer systems, strong PM skills, and the ability to supervise staff. This remote role involves coordinating with internal teams and vendors to drive operational excellence.

Qualifications

• Bachelor’s degree in information systems, computer science, software engineering, health information management or business administration with focus on operations/IT/healthcare.
• 5–7 years’ experience in healthcare systems, specifically payer systems like claims processing and benefit configuration.
• Project Management and staff supervision experience is a plus.

Responsibilities

• Evaluate and improve Core systems and processes for MetroPlusHealth core platforms.
• Track performance related to core systems and vendor activities (claims processing, provider setup, benefit configuration, AP workflows).
• Manage and support business initiatives related to Core systems within budget objectives.
• Ensure SLA performance and escalate concerns to leadership or vendor teams.
• Coordinate communication between business units and core system vendors on shared objectives.
• Advise on new business and operational initiatives and system capabilities.
• Collaborate with Claims Operations, Utilization Management, and Network Management to capture use cases.
• Identify inefficiencies and propose improvements to leaders.
• Monitor provider/state complaints and coordinate responses.
• Maintain visibility into system edits and advise on adjustments.

Skills

Integrity and Trust

Customer Focus

Functional/Technical skills

Written/Oral Communication

Education

Bachelor's degree in Information Systems/MIS / Computer Science / Software Engineering / Health Information Management / Business Administration (Operations, IT or Healthcare focus)

Job description

MetroPlusHealth is seeking a Core Operations Manager to evaluate and improve core systems and applications. You will partner with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to align systems with department and business needs.

The role requires 5–7 years in healthcare payer systems, strong PM skills, and the ability to supervise staff. This remote role involves coordinating with internal teams and vendors to drive operational excellence.