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The Chief Operating Officer, Health Plan Services, leads the operations of health plan services for Medicaid Managed Care Plan product lines, Medicare Advantage Plan Services product lines and other lines of business (LOB). Oversees the Third-Party Administrator (TPA) contractor(s) as well as all vendors and delegates including working with Cook County Health (CCH) financial planning staff and medical group leaders to develop, monitor, and evaluate operating costs and external expenditure budgets, in order to ensure optimal financial and operational performance of the CCH managed care system. This position is responsible for managing all relations with TPAs, delegates and vendors which are external contracted entities.
General Administrative Responsibilities
Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
Participate in collective bargaining negotiations, caucus discussions and working meetings
Document, recommend and effectuate discipline at all levels
Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements
Direct and effectuate CCH management policies and practices
Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements
Contribute to the management of CCH staff and CCH' systemic development and success
Discuss and develop CCH system policy and procedure
General Administrative Responsibilities continued
Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
Work with Labor Relations to discern past practice when necessary
Leads the operations of health plan services for Medicaid Managed Care Plan product lines, Medicare Advantage Plan Services product lines and other of LOB.
This position has primary accountability for directing, managing, coordinating & assuring implementation of provider contracting and relations through working with the TPAs, delegates and vendors.
In conjunction with the TPA, develops & implements programs that support achievement of established patient satisfaction targets
Develops and implements tools for monitoring and evaluating performance objectives and compliance for all contracts, including the TPA and provider contracts
Manages and resolves operational issues, such as assuring claims are being paid in a timely manner, call centers are functioning properly, contracted providers are informed about managed care policies and procedures, etc.
Identifies and monitors trends in enrollment, growth, retention, and expenditures, etc.
Develops and implements resolution plans pertaining to overall health plan operations
Facilitates Plan requirements with managed care initiatives
Analyzes & reports on the status of functional services and any care provided outside the health system
Develops systems & approaches that integrate member health planning & care delivery to ensure the provision of the appropriate type & level of service in a timely manner
Responsible for care delivery strategy and operations, in partnership with the CCH managed care Medical Director and Director of Business Development
Accountable for achieving defined objectives including membership, financial, regulatory, member satisfaction and quality outcomes.
Assures that the implementation of provider contracts meet access, accreditation & regulatory requirements and are consistent with Managed care policies
Achieves and exceeds performance expectations for Managed care operations consistent with TPA and provider contractual performance measures
Performs other related duties as requested
Reports to the to the Chief Administrative Officer, Health Plan Services
Bachelor's degree from an accredited college or university
Five (5) years of management experience with at least three (3) years of experience at a director level or higher in a healthcare environment
Minimum Qualifications continued
Seven (7) years of Managed Care experience in Medicaid and Medicare
Experience and knowledge of health plan operations and demonstrated ability to achieve results on both strategic and operational level
Experience and working knowledge of quality assurance, resource management, health plan regulatory and licensing processes including federal and state laws and regulations
Master's degree from an accredited college or university
Prior experience in a leadership role within an urban, publicly supported, health system
Knowledge, Skills, Abilities and Other Characteristics
Strong problem-solving skills used to anticipate and identify issues and to develop and implement appropriate solutions related to complex administrative processes
Strong interpersonal skills are critical as this position works closely with the TPA, other external customers, and internal members of the Managed care leadership team, internal finance and IT managers and other members of CCH leadership
Strong verbal and written communication skills as this position will frequently present data, trends and performance results to members of upper management and CCH leadership
Strong project management skills
Demonstrated ability to lead and manage change through the use of interpersonal skills such as negotiating, collaborating, and influencing
Strong knowledge of Microsoft Office products (Word, Excel, Access, PowerPoint, etc.)
Physical and Environmental Demands
This position is functioning within a healthcare environment. The incumbent is responsible for adherence to all hospital and department specific safety requirements. This includes but is not limited to the following policies and procedures: complying with Personal Protective Equipment requirements, hand washing and sanitizing practices, complying with department specific engineering and work practice controls and any other work area safety precautions as specified by hospital wide policy and departmental procedures.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of the personnel so classified.
For purposes of the American with Disabilities Act, "Typical Duties" are essential job functions.
To receive Veteran Preference, appropriate discharge papers must be attached to the online application or must be included with your emailed resume/CV. Please refer to Veteran Preference document requirements listed on the bottom of this posting.
When applying for employment with Cook County Health, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service
To take advantage of this preference a Veteran must:
Meet the minimum qualifications for the position.
Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, "Are you a Military Veteran?"
Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable
A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.
If items are not attached, you will not be eligible for Veteran Preference
VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW.
MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.
"Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada muse be credentialed by an approved U.S. credential evaluation service belongings to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview".
*Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.
*CCH is strictlyprohibitedfromconditioning,basing or knowinglyprejudicing or affecting any term or aspect of Countyemployment or hiringupon or because of any politicalreason or factor.
COOK COUNTY HEALTH IS AN EQUAL OPPORTUNITY EMPLOYER.
ABOUT COOK COUNTY HEALTH (CCH)
The Cook County Health’s mission is to deliver integrated health services with dignity and respect regardless of a patient’s ability to pay; foster partnerships with other health providers and communities to enhance the health of the public; and advocate for policies that promote the physical, mental and social wellbeing of the people of Cook County.
CCH is comprised of two hospitals, John H. Stroger, Jr. Hospital and Provident Hospital, a robust network of more than a dozen community health centers, the Ruth M. Rothstein CORE Center, the Community Triage Center, the Cook County Department of Public Health, Cermak Health Services, which provides health care to individuals at the Cook County Jail and the Juvenile Temporary Detention Center, and CountyCare, a Medicaid managed care health plan.
The system cares for more than 300,000 patients each year and its physicians are experts in their fields, committed to providing their patients with comprehensive, compassionate and cutting-edge care. Today, CCH is transforming the provision of health care in Cook County by promoting community-based primary and preventive care, growing an innovative, ...collaborative health plan and enhancing the patient experience.
COOK COUNTY HEALTH IS AN EQUAL OPPORTUNITY EMPLOYER