Senior Manager, Operations

Gold Coast Health Plan will not sponsor applicants for work visas.

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.

Work Schedule: Travel to multiple sites and locations. Work protracted and irregular hours and evening meetings or work irregular hours for attendance at meetings for special projects and programs.

POSITION SUMMARY

Sr. Operations Manager will be a report to the Executive Director, Operations. The Sr. Operations Manager will manage operations functions and is responsible for the effective and successful management of productivity, quality control and strategic measures as established and set for the Operations Department.

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statement(s)

• Ensure effective and efficient operational processes and regulation adherence including validation that all new policies and procedures are implemented
• Provide subject matter expertise in project management and other areas of expertise
• Lead, coordinate and complete operational improvement projects across various functional areas within and outside of Gold Coast Health Plan
• Own end-to-end process improvement: including definition of need, project plans, status updates, reporting and achieving results
• Establish operating metrics and daily, weekly, and monthly scorecards to manage ongoing operations
• Enhance the operational procedures, systems, and principles in the areas of information flow and management, business processes, enhanced management reporting and identification of process improvements
• Develop collaborative relationships with and confirms business partners can execute day-to-day responsibility for operations
• Develop collaborative relationships with matrixed partners and vendors
• Carry out supervisory responsibilities in accordance with company's policies and regulatory requirements
• Inform and advise management regarding California Department of Health Care Services’ current trends, problems and activities to facilitate both short- and long-range strategic plans to improve operational performance
• Direct responsibility of oversight within the Grievance and Appeals department and the Operations Governance work activities to ensure the contractual service and regulatory standards are met and ensure adherence to established policies and procedures regarding appeals and grievances process for both members and providers and adherence to the agreements that exist for delegated entities
• Work closely with Gold Coast Health Plan’s (GCHP) Medical Director and Health Services staff in clarifying and resolving appeals and grievances cases to insure timely and accurate resolution of clinical and quality grievances and appeals.
• Maintain operational procedure, systems, and principles in the areas of information flow and management, business processes, enhanced management reporting and looks for opportunities to improve current processes and control certain aspect of Operational functions.
• Ensure the service and regulatory standards are met and ensure adherence to established policies and procedures regarding appeals and grievances process for both members and providers
• Ensure adherence with contractual responsibilities with regard to operational procedure, systems, and principles in the areas of information flow and management, business processes, enhanced management reporting and looks for opportunities to improve current processes within the delegates and their organizations
• Own operational accountability for the successful system conversions, where applicable
• Identify and resolve technical, operational and organizational problems inside and outside health plan
• Lead teams to resolve business problems that affect multiple functions or disciplines
• Partnering with leadership to develop, maintain, and report data to internal committees, executive staff, regulators and GCHP’s Commissioners.
• Partner with leadership to maintain external contact with regulatory agencies, providers, delegated entities, community-based organizations, and other health plans in all issues relative to grievances and appeals
• Lead and influence staff by fostering teamwork and collaboration, driving employee engagement and leveraging diversity and inclusion
• Drive high-quality execution and operational excellence by communicating clear directions and expectations
• Manage and develop the annual budget for the claims department
• Perform such other duties as assigned

POSITION QUALIFICATIONS

Competency Statements

• Management Skills - Ability to organize and direct oneself and effectively supervise others.
• Business Acumen - Ability to grasp and understand business concepts and issues.
• Decision Making - Ability to make critical decisions while following company procedures.
• Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.
• Interpersonal - Ability to get along well with a variety of personalities and individuals.
• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
• Time Management - Ability to utilize the available time to organize and complete work within given deadlines.
• Relationship Building - Ability to effectively build relationships with customers and co-workers.
• Presentation Skills - Ability to effectively present information publicly.
• Delegating Responsibility - Ability to allocate authority and/or task responsibility to appropriate people.
• Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.
• Strategic Planning - Ability to develop a vision for the future and create a culture in which the long-range goals can be achieved.
• Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.
• Judgment - The ability to formulate a sound decision using the available information.
• Communication, Oral - Ability to communicate effectively with others using the spoken word.
• Communication, Written - Ability to communicate in writing clearly and concisely.
• Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.

SKILLS & ABILITIES

Education: Bachelor's Degree (four-year college or technical school) Preferred, Field of Study: Business, Computer Science, or related discipline or combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

Five to eight (5-8) years of health care operations experience in managed care or related industry is required

Experience: Managed healthcare experience strongly desired.

Computer Skills: Advanced computer skills included in the MS Office products.

Other Requirements:

• Strong interpersonal skills including coaching staff and handling conflict resolution, implementing initiatives or projects, and collaborating with other professional and non-clinical staff.
• Experienced in communicating to multiple levels of an organization and across matrix organizations.
• Skilled at structuring and managing appropriate stakeholder reviews, both formal and informal.
• Ability to manage significant volume of work and prioritize accordingly.
• Proactively manage change and/or conflict, identify and resolve issues with and within the project team.
• Knowledge and understanding of Industry regulations and compliance preferred