What are the responsibilities and job description for the Director, Health Plan Operations position at Priority Health?
Job Summary - Director, Health Plan Operations
The Director of Health Plan Operations will lead operations production capabilities that meet and exceed quality and accuracy metric targets while improving the overall effectiveness and costs of the operations. Capabilities include, but are not limited to enrollment, fulfillment, group administration, premium processing, and accumulator calculations.
Essential Functions - Director, Health Plan Operations
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
SITE - Priority Health - 1231 E Beltline - Grand Rapids
Department Name
PH - Core Operations Leadership
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8:00 a.m. to 5:00 p.m.
Days Worked
Monday through Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
The Director of Health Plan Operations will lead operations production capabilities that meet and exceed quality and accuracy metric targets while improving the overall effectiveness and costs of the operations. Capabilities include, but are not limited to enrollment, fulfillment, group administration, premium processing, and accumulator calculations.
Essential Functions - Director, Health Plan Operations
- Manage the day-to-day operations of a production team and manage strategic opportunities in our Health Plan Operations, driving results within key performance metrics while improving the way business performs
- Optimize end-to-end operations, create efficiencies, enhance quality and position the organization for profitable growth by mitigating the need for incremental administrative costs
- Responsible for supporting department-level and enterprise executives in decision-making, setting strategic goals, driving operations-related investment priorities that position the organization for digital and automation capabilities, and goal setting activities
- Leverages the Lean Six Sigma and operational experiences for all phases of strategic projects
- Develop operational plans that promote long-term success and growth
- Work with the finance department and project managers to develop financial and budgetary plans
- Monitor day-to-day operational systems and implement solutions for improvement if necessary
- Create and implement new operational policies
- Define, implement and maintain operational policies
- Build and implement necessary infrastructure and framework for the overall work environment including but not limited to: policy, procedure, practice, roles and responsibilities, tool assessment and deployment.
- Analyze and interpret data and metrics to evaluate employee performance
- Monitor productivity and create individual performance reviews
- Strategy and process improvement for operations.
- Lead forums and work groups that advance the execution of strategic plans and improve the operation.
- Management of vendors, data, employer solutions operational support and market segmentation analytics.
- Build and maintain relationships with clients, partners, and vendors
- Develop and execute new growth directives
- Communicate with department supervisors and managers to develop financial plans and ensure company-wide compliance
- Required Bachelor's Degree or equivalent Finance, business, or related area
- Preferred Master's Degree or equivalent Business administration or related degree
- 5 years of relevant experience Management Required
- 7 years of relevant experience Process and systems support and improvement in health insurance carrier environment or closely aligned industry. Required
- Developing and initiating a strategic plan for operational effectiveness in a carrier/health plan industry Preferred
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
- On-demand pay program powered by Payactiv.
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance, pet insurance.
- Traditional and Roth retirement options with service contribution and match savings.
- Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
- Waist to Waist > 5 lbs: Seldom up to 10 lbs
- Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
- Waist to Overhead > 5 lbs: Seldom up to 10 lbs
- Bilateral Carry > 5 lbs: Seldom up to 10 lbs
- Unilateral Carry > 5 lbs: Seldom up to 10 lbs
- Pushing Force > 5 lbs: Seldom up to 10 lbs
- Pulling Force > 5 lbs: Seldom up to 10 lbs
- Sitting: Frequently
- Standing: Occasionally
- Walking: Occasionally
- Forward Bend - Standing: Seldom
- Forward Bend - Sitting: Occasionally
- Trunk Rotation - Standing: Seldom
- Trunk Rotation - Sitting: Occasionally
- Reach - Above Shoulder: Seldom
- Reach - at Shoulder or Below: Seldom
- Handling: Occasionally
- Forceful Grip > 5 lbs: Seldom
- Forceful Pinch > 2 lbs: Seldom
- Finger/Hand Dexterity: Frequently
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
- On-demand pay program powered by Payactiv
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance, pet insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
SITE - Priority Health - 1231 E Beltline - Grand Rapids
Department Name
PH - Core Operations Leadership
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8:00 a.m. to 5:00 p.m.
Days Worked
Monday through Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
