Senior Director of Managed Care Operations

Desert Oasis Healthcare; Palm Springs (CA); Hybrid; USD 180.000 - 280.000; Vollzeit

Zusammenfassung

Desert Oasis Healthcare is seeking a Senior Director of Managed Care Operations to lead strategic financial operations, including claims, billing, and informatics across multiple departments. You will drive efficiency, governance, and executive communications while shaping organizational strategy and transformation efforts.

The role requires extensive claims management experience, governance capabilities, and strong collaboration with the CFO and executive team.

Qualifikationen

• Bachelor’s degree required.
• 10 years of claims management experience and 2 years of prior supervisor experience.
• Knowledge of Medicare and DMHC regulations, medical terminology, managed care health plan rules and regulations, ICD-9, CPT and RVS codes.
• Strong organizational skills and the ability to work independently and under pressure.
• Proficiency with Microsoft Office applications and other computer software.
• Current California driver’s license and proof of insurance.
• Discretion for potential full or hybrid telecommuting position.

Aufgaben

• Provide strategic leadership to the Financial Operations division, including Claims, Billing, Eligibility, Benefits, Materials Management, Business Informatics and Contracting.
• Foster accountability and governance across the Finance organization through strong controls and performance management.
• Co‑develop and execute short- and long-term efficiency financial strategies with the CFO and executive team.
• Prepare high-quality executive communications translating financial, regulatory and strategic topics into concise items.
• Oversee MSO functions and informatics infrastructure supporting daily operations and reporting.
• Recruit and retain talent capable of leading critical departments and MSO functions.
• Partner across boundaries to share information, improve decision-making and leverage capabilities.
• Monitor regulatory and financial trends impacting strategy and performance.
• Support the CFO in planning, governance and executive decision-making.

Kenntnisse

Claims management

Leadership

Regulatory knowledge

Organizational skills

Ausbildung

Bachelor's degree

Tools

Microsoft Office

Jobbeschreibung

Description

The Senior Director of Managed Care Operations collaborates with healthcare providers, payers, and internal teams to deliver cost-effective, high-quality patient care. They play a crucial role in the business and administrative side of healthcare organizations, focusing on maximizing revenue and streamlining processes. This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.

Professional Duties

• Provide strategic leadership, mentorship and oversite to members of the Financial Operations division, including but not limited to, Claims, Billing, Eligibility. Benefits, Materials Management, Business Informatics and Contracting departments.
• Foster a culture of accountability, transparency, operational excellence, and enterprise stewardship across the Finance organization through strong and effective governance, controls and performance management.
• Under supervision of the CFO, and working with the Executive Leadership team, co-develop and execute the organizations short- and long-term efficiency financial strategies, ensuring alignment with enterprise goals, growth priorities and transformation initiatives.
• Architect and lead the preparation of high-quality executive communications that translate complex financial, operational, regulatory, and strategic topics into concise, actionable items.
• Serve as the Designated Principal Officer to provide monthly timeliness reports to Health Plans and corporate office.
• Engineer processes that maximize efficiency, effectiveness and resolve deficiencies, while promoting customer service.
• Identifies, recruits and retains great talent, who can lead critical departments and manage MSO functions.
• Oversee and manage the business informatics infrastructure that supports daily operations and EDI functions. This includes electronic medical records, scheduling systems, and reporting tools. Centralized systems improve efficiency and make it easier to monitor performance across locations.
• Forms and maintains effective partnerships across organizational boundaries to share information, improve decision making, and leverage capabilities.
• Monitor emerging healthcare, regulatory, and financial trends that may impact organizational strategy, financial performance, or operational execution.
• Support the CFO in prioritization, strategic planning, governance, and executive decision-making activities.
• Perform other duties, as assigned.

Qualifications

• Bachelors Degree required.
• 10 years of claims management experience and 2 years of prior supervisor experience required.
• Knowledge of Medicare and DMHC regulations, medical terminology, managed care health plan rules and regulations, ICD-9, CPT and RVS codes.
• Strong organizational skills and the ability to work independently and under pressure.
• Ability to utilize Microsoft Office applications (Word, Excel, Outlook, Power Point) and other computer software/applications.
• Current California drivers license and proof of insurance.
• At the discretion of DOHC/FHC management, this position has the potential to be a full or hybrid telecommuting position.

Physical Demands

Type Description

Sitting

Approximately 60% of day.

Standing

Approximately > 20% of day.

Walking

Approximately > 20% of day.

Lifting

0 - 20 lbs. (equipment, supplies) approximately >10% of day.

Bending

Approximately >10% of day. Kneeling <5%.

Hearing/Visual Acuity

Adequate for use with computers, telephone and/or Cellphone. Approximately 90% of day.

Computer

Highly technical work environment. Must be able to work minimum of 6 hours a day using keyboard, mouse and monitor.

Reaching

Above head 75 degrees approximately 10% of day.

Hand grip dexterity

Appr ximately 20% of day