CHIEF OPERATING OFFICER, HEALTH PLAN SERVICES
Job description
Applicants may apply for this position by submitting a resume/ CV to the following email address: mgmtrecruit@cookcountyhhs.org
When submitting a resume/CV by email, you must include the job title and posting number in the subject line of your email. An application or resume/CV must be filed for each position which interests you.
Job Summary
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
Collective Bargaining
- Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
- Participate in collective bargaining negotiations, caucus discussions and working meetings
Discipline
- 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
Supervision
- 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
Management
- 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
Typical Duties
- 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
Reporting Relationship
Reports to the to the Chief Administrative Officer, Health Plan Services
Minimum Qualifications
- 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
Preferred Qualifications
- 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.
VETERAN PREFERENCE
PLEASE READ
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
OR
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 strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor.
COOK COUNTY HEALTH IS AN EQUAL OPPORTUNITY EMPLOYER.
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