Director OH Medicaid COO

Profile

Description

The Director, Market Leadership manages the development, operations, and results of a health plan. The Director, Market Leadership requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

Responsibilities

The Director, Market Leadership (COO) establishes long-range goals, objectives, and plans; monitors financial and operational performance. He/she will be responsible for the strategic development and oversight of operations for Humana's Ohio Medicaid plan. They will manage ongoing operations across multiple levels of the organization to meet operational contract requirements and financial performance goals. They will be accountable for operational results. Represents the health plan externally and to governmental/external agencies.

Position Responsibilities :


Direct and coordinate day-to-day plan functions, including reporting, claims administration, encounter data quality, grievances and appeals, information technology and systems, program integrity and regulatory compliance, member services, provider services, and business continuity planning and emergency coordination
Liaise between the Ohio Department of Medicaid (ODM), plan leadership, and corporate contacts responsible for the execution of contract deliverables
Work with the plan CEO to maintain important stakeholder relationships throughout Ohio
Lead internal infrastructure to review and improve operational functions
Manage implementation of strategic plans developed in cooperation with the plan CEO
Oversee development and maintenance of operational policies and procedures
Effectively implement business plans and oversee audit processes
Own execution of daily operating objectives and goals, including key performance metrics
Plan organizational growth and potential staff successions
Develop and cultivate a diverse and inclusive environment
Maintain intimate familiarity with contractual requirements and stipulations
Understand and actively manage ongoing adherence to local, state, and federal regulatory and programmatic requirements
Mitigate risks potentially impacting the state of Ohio and the plan by proactively monitoring any risk factors and red flags that may arise during operations
Communicate with ODM and direct plan/corporate leadership regarding any necessary operational or regulatory changes
Lead conflict resolution for any provider relations or network issues that may occur


Reporting Relationship :

This position will be report directly to the Ohio Medicaid President.

Educational and Experience Requirements:


Bachelor's degree in Business, Operations Management, Healthcare Administration or related field
Master's degree preferred
Minimum two (2) years of experience in health plan management
Four (4) to six (6) years of experience working in healthcare operations
Experience in strategic and thought leadership in supporting Medicaid health plans preferred
Leadership background with more than five (5) direct-reports


Scheduled Weekly Hours

40

Company info

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