Executive Director Service Operations PHP
Company: Providence Service
Location: Beaverton
Posted on: March 13, 2023
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Job Description:
Description
THE ROLE
Provides operational leadership, management and direction for all
Customer Service teams, including but not limited to member and
provider call support, customer service team support, training,
documentation, analysis, auditing, call coaching, and appeals and
grievance. It may also include responsibility for managing a key
vendor/partner relationships, including negotiations and
contracting. Product lines include Medicare, Medicaid, commercial
group, commercial ASO, and individual plans. Primary membership
base is in Oregon and Southwest Washington, although PHP also has
large ASO clients in Washington, California, Montana and Alaska.
This position holds primary accountability for overall performance
of the above functions for a growing client base in a manner
consistent with the strategic direction of Providence St Joseph
Health.
MAJOR CHALLENGES:
The primary challenge facing the Senior Director, Customer Service
revolves around effective operations of assigned teams to ensure
performance meets PHP strategic initiatives, group retention,
member loyalty and fiscal stewardship. Responding to member &
provider inquiries, requires a constant need for increased
efficiency and automation, which presents a challenge in the light
of increasing complexity of products, plans and regulations. This
includes developing policies, practices, procedures and processes
as well as keeping abreast of industry trends and innovations.
This position is a primary contact between PHP's Operations and IS
departments. Information and data are the core of operations and as
such, effective and efficient IS interfaces are critical. Also, as
administrative costs become a critical factor in Health Plan's
success, the link with IT/IS for technology assistance is vital as
a method of reducing and managing costs.
The health plan world becomes more complex each year, and it is
necessary constantly to monitor organization structure, tools,
training, employee satisfaction and workplace culture. Significant
flexibility is required in this position, as assignments and
priorities may change with little notice.
Incumbent must envision and project the future consistent with
Providence St. Joseph Health for the Health Plans in planning
strategies, integration, growth, and continued success in the
commercial self-funded, and government market.
Incumbent must provide leadership for success of the Health Plans
Operations while continuously scanning the landscape for best
practices that would further enhance efficiency and service.
Incumbent must maintain established service levels in an
environment with regular staff turnover/ turn up.
ESSENTIAL FUNCTIONS
Responsible for the overall service quality and effectiveness of
services provided throughout Health Plans operations. Assures the
proper management, utilization, and enhancement of all resources,
tangible and intangible.
Provides strategic leadership to assigned operating units in a way
that optimize quality, cost effectiveness, competitive edge, and
responsiveness.
Serves as a liaison between PHP Operations and PHP Information
Services for all production, technology assessment & planning,
vendor analysis, as well as development and project work. Supports
Agile processes including sponsorship and oversight as
appropriate.
Develops standards, policies, and performance objectives for
assigned Operations departments.
Strives towards excellence in the attraction and development of
Health Plan Operations professionals. Selects and develops leaders
who will meet the qualitative, quantitative, and mission related
goals of this area of responsibility. Provides leadership,
encouragement, and support to all Health Plan personnel by
maintaining high standards of performance and delivery of
service.
Responsible for preparing and maintaining assigned portion of
Operations strategic plan, including the annual budget; has major
responsibility for optimizing productivity and cost effectiveness
throughout the operations and for identifying and monitoring key
success measures.
Develops and monitors Operations organizational structure,
including the delegation of duties and organizational development
of key staff. Fosters team work and creates a culture of employee
empowerment.
Monitors staff training and performance for assigned departments,
including new employee training as well as a comprehensive program
designed to cross train employees in all functional areas.
Maintains knowledge of the market throughout the Northwest and the
PSJH Regions.
Provides the vision and leadership necessary to establish future
directions, develop appropriate strategies, and direct their
implementation for the operations of the health plans.
Establishes positive working relationships with physicians, vendors
and other business entities throughout Providence Health &
Services.
Represents PHP Operations and services to clients, potential
clients, consultants and other community constituents in an
appropriate manner as opportunities arise.
Keeps abreast of, and recommends to senior management, the latest
technology improvements in telephony services, customer service,
digital platforms, workforce management applications linkages, and
core operational procedures.
Responsible for identifying key capital needs for PHP Service
Operations.
In conjunction with Information Services & Planning, evaluates and
prioritizes key work projects and monitors progress while managing
the utilization of scarce resources.
Oversight of Appeal and Grievance activities.
As needed, assumes DRI (Direct Responsible Individual) role for
projects and other relationships and initiatives.
IDEAL QUALIFICATIONS
Required experience/education for this position include:
Bachelor's Degree in Healthcare Administration, Business
Administration or other related field.
10 or more years of Experience in health plan operations
5 years in a senior Management role (Director level)
A track record showing the ability to effectively communicate
organizational planning as well as effectively develop and meet
budget requirements
A deep understanding of all Health Plan Functions and successful
application of project management skills, performance management
skills and techniques, and demonstrated use of continuous quality
and efficiency improvement tools
A deep demonstrated understanding of all Health Plan offered
products and services
Demonstrated strong interpersonal skills internally within area of
direct responsibility as well as all other areas within Service
Operations, PHP, and PSJH as a whole
Demonstration of strong team building skills and shown persuasive
communication abilities
Must be able to demonstrate the ability to work within team
settings to enhance shared leadership philosophies, and to inspire
and motivate managers to create and lead strong teams
Must demonstrate innovative improvements to existing processes to
create efficiencies
Must be able to show an understanding of the importance and impact
of quality initiatives to PHP - such as NCQA, HEDIS, and Medicare
Five Star - and demonstrate support and improvement where
needed
Must have an understanding of phone and workflow related
technologies with proven ability to make needed changes to improve
quality and efficiency.
Preferred experience/education for this position include:
About Providence
At Providence, our strength lies in Our Promise of "Know me, care
for me, ease my way." Working at our family of organizations means
that regardless of your role, we'll walk alongside you in your
career, supporting you so you can support others. We provide
best-in-class benefits and we foster an inclusive workplace where
diversity is valued, and everyone is essential, heard and
respected. Together, our 120,000 caregivers (all employees) serve
in over 50 hospitals, over 1,000 clinics and a full range of health
and social services across Alaska, California, Montana, New Mexico,
Oregon, Texas and Washington. As a comprehensive health care
organization, we are serving more people, advancing best practices
and continuing our more than 100-year tradition of serving the poor
and vulnerable.
The amounts listed are the base pay range; additional compensation
may be available for this role, such as shift differentials,
standby/on-call, overtime, premiums, extra shift incentives, or
bonus opportunities.
Check out our benefits page for more information about our Benefits
and Rewards.
Requsition ID: 116663
Company: Providence Jobs
Job Category: Member Services Enrollment & Billing
Job Function: Health Plans Services
Job Schedule: Full time
Job Shift: Day
Career Track: Leadership
Department: 5018 OPS PHP CSO OR REGION
Address: OR Beaverton 3601 SW Murray Blvd
Pay Range: $66.13 - $115.64
The amounts listed are the base pay range; additional compensation
may be available for this role, such as shift differentials,
standby/on-call, overtime, premiums, extra shift incentives, or
bonus opportunities.
Check out our benefits page for more information about our Benefits
and Rewards.
Providence is proud to be an Equal Opportunity Employer. Providence
does not discriminate on the basis of race, color, gender,
disability, veteran, military status, religion, age, creed,
national origin, sexual identity or expression, sexual orientation,
marital status, genetic information, or any other basis prohibited
by local, state, or federal law.
Keywords: Providence Service, Beaverton , Executive Director Service Operations PHP, Executive , Beaverton, Oregon
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