Senior Manager, Operations G & A

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive.  This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on 5 Core Values in the workplace:

•    Integrity

•    Accountability

•    Collaboration

•    Trust 

•    Respect

Disclaimers:

•    Flexible work schedule is based on job duties, department, organization, or business need.

•    Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

The Senior Manager, Operations G & A is responsible for overseeing the day-to-day operational functions. The Senior Manager, Operations G & A will need to ensure compliance with regulatory requirements, efficient processes, and high-quality service delivery to members and providers.  The leader will direct and coordinate cross-functional teams, including Eligibility & Enrollment, Grievance & Appeals, and other operational support areas. 

Amount of Travel Required: 10%-30%

Work Schedule: Travel to multiple sites and locations. Work protracted and irregular hours and evening meetings or work irregular hours for attendance at meetings for special projects and programs.

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statements

•    Ensure effective and efficient operational processes and regulation adherence including validation that all new policies and procedures are implemented

•    Provide leadership and operational oversight of core functions such as Enrollment & Eligibility, Claims Operations, Appeals & Grievances, and other vendor-supported services. 

•    Lead, coordinate and complete operational improvement projects across various functional areas within and outside of Gold Coast Health Plan

•    Own end-to-end process improvement: including definition of need, project plans, status updates, reporting and achieving results

•    Establish operating metrics and daily, weekly, and monthly scorecards to manage ongoing operations 

•    Enhance the operational procedures, systems, and principles in the areas of information flow and management, business processes, enhanced management reporting and identification of process improvements 

•    Collaborate with departments including Compliance, Quality, Finance, Clinical and IT to support enterprise-wide initiatives and projects

•    Represent the operations department in cross-departmental meetings and planning activities.

•    Lead and support implementation of new programs, systems, or regulatory changes.     

•    Carry out supervisory responsibilities in accordance with company's policies and regulatory requirements

•    Inform and advise management regarding California Department of Health Care Services’ current trends, problems and activities to facilitate both short- and long-range strategic plans to improve operational performance

•    Direct responsibility of oversight within the Grievance and Appeals department and the Operations Governance work activities to ensure the contractual service and regulatory standards are met and ensure adherence to established policies and procedures regarding appeals and grievances process for both members and providers and adherence to the agreements that exist for delegated entities 

•    Work closely with Gold Coast Health Plan’s (GCHP) Medical Director and Health Services staff in resolving appeals and grievances cases by insuring timely and accurate resolution clinical grievances and appeals. 

•    Maintain operational procedures, systems, and principles in the areas of information flow and management, business processes, and reporting. 

•    Develop opportunities to improve current processes and control certain aspect of Operational functions.

•    Ensure the service and regulatory standards are met and ensure adherence to established policies and procedures regarding appeals and grievances process for both members and providers.

•    Identify and resolve technical, operational and organizational problems inside and outside health plan.

•    Partnering with leadership to develop, maintain, and report data to internal committees, executive staff, regulators and GCHP’s Commissioners. 

•    Lead staff by fostering teamwork and collaboration, driving employee engagement as well as leveraging diversity and inclusion

•    Drive high-quality execution and operational excellence by communicating clear directions and expectations

•    Manage and develop departmental budget 

•    Perform such other duties as assigned

POSITION QUALIFICATIONS

Competency Statements

•    Management Skills - Ability to organize and direct oneself and effectively supervise others.

•    Business Acumen - Ability to grasp and understand business concepts and issues.

•    Decision Making - Ability to make critical decisions while following company procedures.

•    Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.

•    Interpersonal - Ability to get along well with a variety of personalities and individuals.

•    Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

•    Time Management - Ability to utilize the available time to organize and complete work within given deadlines.

•    Relationship Building - Ability to effectively build relationships with customers and co-workers.

•    Presentation Skills - Ability to effectively present information publicly.

•    Delegating Responsibility - Ability to allocate authority and/or task responsibility to appropriate people.

•    Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.

•    Strategic Planning - Ability to develop a vision for the future and create a culture in which the long-range goals can be achieved.

•    Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.

•    Judgment - The ability to formulate a sound decision using the available information.

•    Communication, Oral - Ability to communicate effectively with others using the spoken word.  

•    Communication, Written - Ability to communicate in writing clearly and concisely.  

•    Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.  

SKILLS & ABILITIES

Education: Bachelor's Degree (four-year college or technical school) Preferred, Field of Study: Business, Computer Science, or related discipline or combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position in lieu of a bachelor’s degree.

Experience:    

•    Minimum of 3 years in a managerial or leadership role

•    Minimum of five to eight (5-8) years in managed care operations or health plan administration. care or related industry is required

•    Experience with Medi-Cal (Medicaid), Medicare, and or Dual-eligible Special Needs Plans (D-SNP) strongly preferred.  

•    Experience with either Eligibility, Claims, or Grievance & Appeals preferred

Computer Skills:  Advanced computer skills included in the MS Office products. 

Certifications & Licenses: A valid and current Driver's License, Auto Insurance, and professional licensure(s)

Other Requirements:

•    Strong interpersonal skills including coaching staff and handling conflict resolution, implementing initiatives or projects, and collaborating with other professional and non-clinical staff.

•    Experienced in communicating to multiple levels of an organization and across matrix organizations.

•    Skilled at structuring and managing appropriate stakeholder reviews, both formal and informal.

•    Ability to manage significant volume of work and prioritize accordingly.

•    Proactively manage change and/or conflict, identify and resolve issues with and within the project team.

•    Knowledge and understanding of Industry regulations and compliance preferred