Director Managed Care Enrollment and Systems
US-CA-BAKERSFIELD
commonspirit_careers
Req #: 380664
Type: Day
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Overview: ***This position is remote/work from home within California. The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first. Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave. Responsibilities: ***This position is remote/work from home within California. Working in a collaborative environment, the Director will be a hands-on leader to the Enrollment and Benefit team, responsible for eligibility, benefit plans and contract configuration. This is an exciting opportunity for an experienced leader to mentor and grow their team, while working cross-functionally on the design, build and growth of the department. Experience with IPA or network managed care, EZCAP and analytics strongly preferred. Position Summary: Provide leadership oversight to Managed Care Platform configuration and operations teams, inclusive of benefits, enrollment, and fee schedule implementation functions for new or revised business. Provides strategic direction and tactical leadership to ensure proper administration and compliance of health plan benefits, provider contracts, and enrollment of members. Coordinates with health plan partners, Managed Care platform vendors, and offshore support teams. Compiles and analyzes departmental production data, shifting priorities as necessary. Responsible for developing and implementing policies and procedures, monitoring performance and quality metrics, and resolving escalated issues. Collaborates with cross departmental/divisional leaders, such as Contracting, Utilization Management (UM), and Claims Directors as necessary to meet the business needs of the organization, specifically supporting enrollment and system configuration activities. Responsibilities may include: - Develop and implement strategic plans for the benefits, enrollment, and configuration functions to align with the overall goals of the Dignity Health MSO. - Establish and enforce policies and procedures to ensure compliance with regulatory requirements and industry standards. - Oversee the implementation and management of health plan benefits and Division of Financial Responsibility (DOFRs), ensuring the accurate configuration of the system to support downstream processes. - Oversee the development and management of enrollment processes, ensuring accuracy and efficiency. - Oversee the configuration of fee schedules to ensure appropriate implementation of the provider contracts and downstream process accuracy. - Manage relationships with offshore vendors, negotiating contracts, ensuring service levels are met, and supporting any risks or escalations. - Manage the relationship with the Managed Care Platform vendor, managing and monitoring the contract, coordinating issue resolution, and partnering to driving continuous improvement - Ensure high levels of member satisfaction by overseeing the resolution of enrollment or benefit related issues and inquiries. - Identify opportunities for system enhancements and work with IT to implement changes. - Ensure the accuracy and reliability of system configurations through rigorous testing and quality assurance processes. Qualifications: Minimum Qualifications: - 5+ years of management experience in a team production (claims processing) environment. - Bachelor's degree in business administration/healthcare administration management with a concentration in information systems or related field, or equivalent experience. Preferred Qualifications: - 10+ years of management experience in a team production (claims processing) environment preferred - Previous senior management experience including responsibilities for hiring, training, assigning work and managing performance of staff preferred. - Experience in the managed care field, with an IPA, network, or other healthcare related environment strongly preferred. - EZCAP experience strongly preferred. - Strong analytics experience preferred. #LI-DH
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