Director of Health Plan Operations - ProCare

Company: Cantex Continuing Care Network
Location: Carrollton
Posted on: May 25, 2023

Job Description:

Job Details

Job Location
Cantex Continuing Care Network LLC - Carrollton, TX

We are committed to providing the highest level of innovative, compassionate, and quality health care services to yield optimal outcomes and value for our patients, families, team members, and the communities we serve.

Job Summary:

The Director of Operations, ISNP for the ProCare Advantage Plan is responsible for and oversees all activities supporting Network Relationships, Value Based Contracting Initiatives, Plan Enrollment, Operations, member and provider support.

Qualifications:

• Bachelor's degree in Health Care Administration, Business, or Management
• 5+ years of experience in SNF, hospital, managed care case management or discharge planning desirable
• Experience in a call center setting processing incoming referrals for admissions
• Knowledge and experience with healthcare payers such as Medicare, Medicaid, and managed care plans
• Technical and financial understanding of health care operations
• Ability to advise IT resources related to enterprise platform initiatives
• Exceptional leadership skills and operational management expertise
• Excellent communication skills
• Strong analytical and problem-solving skills
• Working knowledge of relevant federal and state regulations and requirements
• In depth understanding of challenges that face health plans and health care in general
• Ability to stay apprised of ongoing changes that impact health plan operations Essential Functions:
  
  • Responsible for and oversees all activities supporting Network Relationships, Value Based Contracting Initiatives, Plan Enrollment, Operations, member and provider support
  • Along with the Senior Management Team sets strategies, goals, programs, best practices and compliance improvement projects for improving operational execution and delivering on our value proposition to customers and members
  • Establishes member growth programs and manages campaigns to achieve top line revenue targets
  • Leads and recommends maximization activities such as risk score improvements
  • Develops and oversees marketing and member outreach activities
  • Ensures regulator and vendor contractual compliance requirements including correspondence management and regulatory reporting
  • Achieves all regulator established and internal operating metrics
  • Achieves member and provider satisfaction goals and improvement programs
  • Oversees the development and implementation of all health plan policies and procedures
  • Manages network strategy, adequacy, access and service
  • Assesses operating business risks/opportunities and identify strategies to mitigate/capitalize as appropriate.
  • Directs due diligence and integration of new business.
  • Achieves targeted employee engagement and satisfaction scores for the health plan
  • Achieves financial profitability targets for the health plan
  • Collaborate with facility leaders in order to support member needs at each location
  • Coordinating the patient referral and approval process in an efficient manner.
  • Establishing & maintaining relationships with external business development team for the purpose of generating consistent admissions to the plan.
  • Understand the admissions process including policy, procedures, assessments & paperwork requirements.
  • Maintain knowledge of regulations governing Medicare/Medicaid/Managed Care reimbursement processes.
    
    DEI Mission Statement:
    
    Diversity, Equity, and Inclusion are at the heart of Cantex. We are committed to a culture that respects our differences and values the contributions of all people.

Keywords: Cantex Continuing Care Network, Carrollton , Director of Health Plan Operations - ProCare, Healthcare , Carrollton, Texas