Health Insurance Operations Director jobs in Seattle, WA

Description

THE ROLE

Provides leadership and oversight for clinic operation at multiple sites. In partnership with the Medical Directors, this position is responsible for setting expectations in the areas of medical quality, service access, utilization, finance, productively and operational excellence. Support the medical directors in improving and maintaining provider productively and service quality. Represents the clinics in organizational projects, committees and initiatives.

Responsible for implementing the Providence Medical Group strategic and financial goals in the area of reasonability. Optimizes services to achieve the highest levels of patient satisfaction and successfully manages to organizational benchmarks in the areas of medical quality, utilization, service/access, and financial performance. Develops management and assisting in the professional growth of support staff within the NWSA PMG clinics.

Responsible for collaboration with population health services, payors, and System government advocacy departments with ownership of execution and management of new business models (such as PCP capitation) that are directly tied to improved management of PMG's covered lives and cost of care.

ESSENTIAL FUNCTIONS

• Develops and implements processes to ensure the efficient and cost-effective operation of new and existing clinic sites while meeting organizational strategic and financial goals.
• Provides strategic and operational oversight for implementation of programs through development, of quality and effective clinic operations for new and existing service lines.
• Is part of the PMG senior leadership team and is as an effective team member sharing information on guidelines and processes for quality improvement related to Primary Care management and Revenue Integrity team.
• Responsible for strategic oversight of all NWSA and PSJH initiatives/projects as directed by the COO/CMO.
• Cultivates new practices and/or new services are developed to meet patient population(s) requirements. Maintain current knowledge in the field of ambulatory care clinics
• *In collaboration with Population Health teams- works to operationalize and manage new business models that are overlaid upon primary care that improve overall PMG panel management and drive down cost of care. This may include examples such as direct contracting to employers for primary care and delivering on primary care capitation models with insurers.
• Financial Management/Planning and Development:
• In collaboration with management team, develop the annual clinic budget at each site and ensures it is used as an effective management tool.
• Leads and has broad strategic accountability for the financial success of the clinic and achievement of financial goals.
• Responsible for the overall management and performance of new business models – i.e. capitation and risk arrangements –as adopted within primary care and successfully meeting utilization and cost of care targets.
• Leadership:
• Responsible for daily leadership in the clinic sites to achieve the highest levels of patient and employee satisfaction.
• Leads and promotes compliance in the clinic sites with the performance management system and progressive discipline as needed in accordance with the Human Resources policies
• Serves as a mentor to clinic management staff and ensures compliance with State and organizational policies.
• Provides strategic leadership with the recruitment and retention of high-quality staff for each clinic site.
• Partners with the Medical Director at each site in the recruitment and retention of high-quality medical staff.
• Directs managerial growth of primary care managers and supervisory staff at the sites.
• Provides leadership and coordination with population health, payors, and government services in order to maximize the impact and effectiveness of new business models in primary care.
• Human Resources:
• Responsible for timely employee performance evaluations according to PH&S policy.
• Provides strategic oversight for core leaders to manage and document employee performance issues; uses progressive discipline appropriately per PMG policies and procedures.
• Guides and directs the hiring and orientation of employees utilizing behavioral interview materials.
• Responsible for compliance of employment laws, contractual agreements and employment policies and procedures.
• Develops and ensures department specific competency-based training and meetings.

QUALIFICATIONS

• Bachelor's Degree in Health Administration or Business Administration; or equivalent educ/experience
• And/Or a combination of education and directly related progressive expanded work experience in healthcare clinics and administration
• 5 years of progressive experience, managing complex healthcare administrative projects and business units, and governance support to senior leadership
• 3 years of specific experience working with senior leaders teams, matrix leadership in a region or enterprise
• Demonstrated strong business acumen and a deep understanding of clinic leadership in Primary Care and Revenue capture with the proven ability to develop and implement strategic initiatives with emphasis on solutions that provide business value
• Strong analytic skills with the ability to gather, interpret and utilize data to improve overall clinic operations
• Must have proven ability to interact and communicate to all levels of the organization
• Demonstrated organizational, interpersonal, and communication skills and the ability to manage shifting priorities are critical for this position
• Financial, business development, complex project management, team building, and collaborative working skills are essential
• Proven change management skills including crafting of strategic direction and effectively directing/managing tactical processes
• Must be adaptable: dealing with daily operations, related problem solving, physician relations, while retaining strategic focus and driving long term results
• Knowledgeable and skills in medical group management and health systems operations and reimbursement.

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: 241523

Company: Providence Jobs

Job Category: Patient Care (Non-Acute)

Job Function: Clinical Care

Job Schedule: Full time

Job Shift: Day

Career Track: Leadership

Department: 3001 PMG ADMINISTRATION WA

Address: WA Everett 1717 13th St

Work Location: Regional Cancer Center-Everett

Pay Range: $72.72 - $117.05

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.