Associate Chief Operating Officer, Health Plan Services - Cook County Health : Job Details

Job Summary

The Associate Chief Operating Officer, Health Plan Services, assists in leading 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).Works with the Chief Operating Officer (COO) to oversee 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

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

Assists in leadings the operations of health plan services for Medicaid Managed Care Plan product lines, Medicare Advantage Plan Services product lines and other of LOB.

Provides support to the COO in directing, managing, coordinating and assuring implementation of provider contracting and relations through working with the TPAs, delegates and vendors.

In conjunction with the COO, 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

Collaborates with the COO to facilitate Plan requirements with managed care initiatives

Analyzes and reports on the status of functional services and any care provided outside the health system

Works with the COO to develop systems and approaches that integrate member health planning & care delivery to ensure the provision of the appropriate type & level of service in a timely manner

Assists with the 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 and 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

Minimum Qualifications

Bachelor's degree from an accredited college or university, is required (must provide official transcripts at time of interview)

Five (5) years of Managed Care experience in Medicaid and Medicare, is required

Four (4) years of management experience with at least three (3) years of experience at a director level or higher in a healthcare environment, is required

Experience and knowledge of health plan operations and demonstrated ability to achieve results on both strategic and operational level, is required

Experience and working knowledge of quality assurance, resource management, health plan regulatory and licensing processes including federal and state laws and regulations, is required

Preferred Qualifications

Master's degree from an accredited college or university, is preferred (must provide official transcripts at time of interview)

Prior experience in a leadership role within an urban, publicly supported, health system, is preferred

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.

FILING.PLEASE NOTE :

IF YOU HAVE MULTIPLE DD 214S, 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 911) OR THE DEPARTMENT OF HOMELAND SECURITY (AFTER 911).

VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS AT TIME OF INTERVIEW.

Benefits Package

• Medical, Dental, and Vision Coverage
• Basic Term Life Insurance
• Pension Plan and Deferred Compensation Program
• Employee Assistance Program
• Paid Holidays, Vacation, and Sick Time
• You may also qualify forthe Public Service Loan Forgiveness Program (PSLF)