Director of Strategic Operations

Network Health’s success is rooted in its mission to create healthy and strong Wisconsin communities. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking a Director of Strategic Operations to support the implementation of Network Health serving as Third-Party Administrator (TPA) and provides management oversight of the claims and enrollment activities within scope of that TPA.

The Director of Strategic Operations provides support to both the Vice President of Strategic Operations and Vice President of Operations. This role is also responsible for collaboration with fellow Directors of Operations to establish procedures, processes, performance standards and provide the necessary oversight and leadership on operational activities.

Duties:

• Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health.
• Oversee the operational activities of both TPA Claims and Enrollment departments, ensuring regulatory compliance and developing goals/metrics to achieve high performance standards.
• Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies. Complying with standard practices in QNXT, EAM, NetworX Optum PPS and Rate Manager systems. Maintain data accuracy to ensure service level agreements are met for the systems and customers being supported.
• Work with the Vice President of Strategic Operations:
  • Establishing procedures, processes, standards and policies necessary for Network Health to operate as a TPA.
  • Developing employee base for TPA operations in a manner that achieves high overall employee satisfaction, successful recruitment initiatives and a positive work environment o developing operational goals for offered TPA service.
  • Assist in developing strategies and initiatives that will promote process improvements and increase operational efficiencies.
  • Collaborate with other members of the management teams in the development of a program designed to improve the quality of services, outcomes, and the level of member and provider satisfaction.
  • Other duties as assigned.

Requirements:

• Associate degree or 8 years of equivalent work experience may be substituted.
• 8 years of insurance or managed care experience is required.
• At least 5 years in a health insurance leadership role.
• Requires a strong understanding of Claims, Enrollment and Customer Service and Payment Integrity.
• 2 years’ experience with QNXT, other Cognizant products, or Optum Products as subject matter expert system user or background in configuration for similar database structured system in health or another industry
• Additional experience in Health Insurance Exchange, Accountable Care Organization, Medicare, Medicaid, and/or integrated healthcare systems is preferred.
• Previous experience with supporting Third-Party Administrator functions is preferred.
• Previous experience or involvement in system upgrades, implementations and cost trend initiatives preferred.

Skills:

• Intermediate Microsoft Office skills, specifically Excel, Outlook, Word and PowerPoint.
• Results oriented and able to thrive within a fast paced, energized and entrepreneurial environment.
• Proven ability to provide leadership, vision and direction within a fast moving, challenging and energetic environment.
• Demonstrated history of leading teams through successful change management.
• Possesses analytical, strategic, business planning, communication, and teamwork/collaboration skills.
• Excellent oral and written communication skill.
• Time management, organizational skills, good decision making and judgment skill.
• Requires HIPAA Privacy and Security understanding ensuring that Operations staff complies with HIPAA privacy and security laws and all other federal, state, and local regulations.
• Ability to conduct oneself in a manner which promotes quality and service excellence for clients, members, physicians, staff, and visitors and contribute to the spirit of teamwork within Network Health.

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce.