VP Operations MFC

Baltimore, MD, United States

Bachelor's degree Business Administration, health care administration or related field

10+ years Increasingly responsible senior management experience in health plan operations or healthcare administration required

Thorough knowledge of health plan operations in a Medicaid health plan

Deep understanding of health plan systems and technology

Expertise in health plan network management, including value-based care and reimbursement strategies

Highly effective leadership skills, with focus on driving successful execution, professional development and associate engagement

Responsibilities The Vice President of Operations will ensure that MedStar Family Choice has the operational and technical infrastructure in place to meet both short- and long-term strategic goals

As a member of the Senior Leadership Team, the VP has primary responsibility for the direction of MedStar Family Choice operations and technology strategy, programs, and investments, driving a range of initiatives to improve business processes and company performance

The Vice President of Operations leads and executes all administrative operational components of the organization

Responsibilities include planning, directing, organizing, controlling, and implementing strategic plans and policies that will ensure a functionally sound operations structure and successful execution for all objectives

The VP will have oversight for vendor supported shared services functions supporting service delivery to MedStar Family Choice's customers and providers, including Administrative Operations, (Enrollment, Configuration and Benefit Operations), Delegated Vendor Oversight, Appeals and Grievances, Payment Integrity and Centralized Care Management and Pharmacy Management platforms

Responsible for oversight of all Medicaid operations functions, including enrollment, premium billing, plan benefits and configurations, and provider reimbursement, and claims management, appeals and grievances and delegated vendor oversight

Ensures that plan services and operations are performed in an efficient, high quality, and fully compliant manner, providing optimal service to our members and providers

Ensures that optimal operating business processes, applications, technology solutions and equipment are in place to maximize the operational results of the organization

This includes the continuous evaluation of and upgrades, as appropriate, to support systems (telephone technology, PC/software, printers, workspace design, file retrieval systems, etc.) working collaboratively with Information System colleagues

Oversees the development and execution of policies, workflow, and procedures for all operations activities

Ensures that operational performance measures are in place to ensure that critical performance areas (productivity, service, quality, compliance, etc.) are being continuously monitored and improved

Ensures that all operations activities are performed in a manner that is fully compliant with federal, state, and local laws and regulatory requirements

Provides executive oversight in collaboration with the Chief Medical Officer of MedStar Family Choice contract relationships with MedStar Family Choice's Pharmacy Benefit Manager (PBM)

Oversee the strategic vision for analytics, innovation, and in identifying opportunities for the enhanced use of clinical information systems to improve healthcare and clinical service performance

Develop and implement a provider data and general performance management strategy to help providers better manage their risk

Oversight of the development of enterprise-wide standards to ensure compatibility and integration of analytical systems with other IT platforms

Embed outcomes based analytic approaches and expertise into decision making and business processes throughout MedStar Family Choice

Participate in and drive strategic transformation and innovation of enterprise systems to improve outcomes and to effectively leverage MedStar Family Choice's capabilities

Works collaboratively with the Senior Leadership Team on all aspects of performance and process improvement related to clinical services and platforms obtained by MedStar Family Choice members

Collaborates and contributes to the medical cost control agenda, and the partnership between the Executive Director & Chief Medical Offer to manage MedStar Family Choice's relationship with providers in Maryland and the District of Columbia

Works collaboratively with the Chief Medical Officer to oversee policies related to medical management that result in optimum cost and benefit for the organization while complying with all legal and regulatory compliance requirements

Works collaboratively with the Executive Director(s) for strategic oversight of all functions related to development, management and maintenance of MedStar Family Choice's provider network, including provider data and reimbursement policy

Collaborate with the Executive Director(s) to lead the strategic development & expansion of the provider network (physician, hospital and ancillary services) in Maryland and the District of Columbia, for the Medicaid products to provide needed healthcare services to fulfill contractual obligations and to meet current & future business needs

Collaborates with the Executive Leadership team to oversee the development and implementation of strategies to support network cost and quality performance and the corporate mission through clinical programs and policy, care management and utilization management, provider network contract models, incentives (P4P), targeted initiatives and reimbursement methodologies

Oversees all computing and information technology strategic plans, policies, programs and schedules for business data processing, computer services, network communications, and management information systems and services to accomplish corporate goals and objectives

Working collaboratively with the VP of Information Technology to oversee all information technology functions of the company

This includes all data centers, technical service centers, help desks, communication networks (voice and data), computer program development, and business systems operations

Responsible for ensuring the security of data, information systems, communication lines and equipment

Acts to assure integrity of corporate data and proprietary information through information security and access management protocols that meet regulatory compliance standards

Oversees the development, implementation and on-going assessment/refinement of all back-up and disaster recovery programs, cyber security policies and procedures

Establish strategic service provider partnerships and manage outsourced services, maximizing the mix of in-house versus outsourced services to optimize cost of services

Selects, manage, and control information technology service providers

Oversees information technology planning and policy-making committees

This includes oversight of the Corporate Project Management Office and Corporate Agenda projects

Oversees business system and related business process support, providing specialized expertise to ensure that business groups optimize the capabilities of business systems and the associated processes

Oversees the performance of the strategic outsources providing technology services and back-office services ensuring that the outsources exceeds or meets its contractual obligations with established financial parameters

Comprehensive total rewards package - including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more

More career opportunities closer to home - as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations

Company information

MedStar Health is a not-for-profit health system dedicated to caring for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. MedStar’s 30,000 associates, 6,000 affiliated physicians, 10 hospitals, ambulatory care and urgent care centers, and the MedStar Health Research Institute are recognized regionally and nationally for excellence in medical care. As the medical education and clinical partner of Georgetown University, MedStar trains more than 1,100 medical residents annually. MedStar Health’s patient-first philosophy combines care, compassion and clinical excellence with an emphasis on customer service.

Pharmaceuticals, Medical Devices, Healthcare Services, Healthcare, Healthcare IT, Hospitals, Health and Wellness, Research, Medical Services, Medical Device

Company Specialties:

Cardiology, Cardiac Surgery, Oncology Services, Rehabilitation, Neurosciences, Orthopaedic Surgery, Women's Services, and Emergency and Trauma Services

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