Chief Operating Officer, St. Luke's Health Plan

At St. Luke’s we take a great deal of pride in our ability to provide quality care for the people of Idaho. Rather than expand nationally, we've focused our efforts locally, caring for more than 260,000 people across southwestern Idaho. St. Luke’s Health Plan, a new Idaho-based health insurance company, is the next opportunity for local focus. Backed by more than 120 years of service to Idaho, the Health Plan was created because Idahoans deserve better from their health insurance. We are striving to do just that, all together, as a team of insurance and providers working for Idahoans. St. Luke’s Health Plan exists specifically to connect people to affordable, hassle-free healthcare. If you are motivated by building better and want to help grow a new company that will make a difference in the lives of all Idahoans, come join the St. Luke’s Health Plan team!

For more information on St. Luke's Health Plan, visit https://stlukeshealthplan.org/

Position Summary

The Chief Operating Officer (COO) partners with the Health Plan executive leadership team and is responsible for management of all business operations and performance, including affecting change to improve service, simplify workflows, and assure compliance with regulatory requirements. This role implements and maintains Health Plan administrative functions, programs, products, procedures, and controls to assure effective communication with stakeholders and meet the overall business goals of the Health Plan.

• Collaborates with executive leadership on strategy and business planning to achieve business goals and strategic objectives of the organization. Supports Health Plan leadership team to implement new clinical, quality and affordability initiatives.
• Engages directly with the Board of Directors to ensure operational transparency and to communicate critical organizational goals, priorities, and objectives and key results for Health Plan operational functions.
• Partners with the executive leadership to achieve favorable results concerning member experience, sales, partnerships, cash flow, systems, reporting, and controls.
• Ensures all operational activities conform to contract compliance for all lines of business. Understands state and federal legal and contractual regulations and requirements; translate requirements into operational metrics and protocols.
• Makes recommendations as to the use and selection of external vendors. Ensures there is appropriate operational leadership and oversight to vendors to ensure optimal customer experience. Identifies cost effective technologies, workflows and sourcing partnerships necessary to meet strategic commitments.
• Partners with key stakeholders to assure coordination of finance, provider development, product design, utilization controls and efficient operations.
• Ensures ongoing programmatic excellence, thorough program evaluation, and consistent quality of administration, communications, and systems.
• Sets policy, procedure, and provides direction and structure for Health Plan customer and member services, claims administration, and medical management teams.
• Identifies and implements performance opportunities including those to improve member and provider experience, efficiency and accuracy. Owns end-to-end process improvement with an emphasis on improved efficiencies and cross-functional communication and collaboration.
• Serves as the subject matter expert (SME) for core payer operations contributing to interpretation and guidance for new and emerging rules and regulations at both the state and federal level.
• Ensures accuracy of medical claims processing system. Monitors third-party vendor and/or internal claims processing and ensures quality review processes are in place.
• Provides leadership in developing, implementing, and communicating short and long-range plans, goals, and objectives for the function. Aligns team goals with the organization’s vision and strategy. Manages the organization to ensure results are achieved across functions and various lines of business.
• Creates an environment of integrity, compassion, accountability, respect, and excellence and promotes a culture of learning and innovation to facilitate the development of the strategic plan and the achievement of the strategic and operational goals of the organization. 
• Responsible for full employmentlife cyclefor staff to include hiring, termination, performance management, coaching, training, and mentoring to staff.
• Performs other duties as assigned.

• Education: Master’s degree in business administration, healthcare administration, or related field
• Experience: 10 years relevant experience
• Licenses/Certifications: None