DIRECTOR OF OPERATIONS, RISK TRANSFORMATION
Business Offices Full Time
2S. Cascade Ave., #140 ,
United States Of America
The Director of Operations, Risk Transformation reports to the Vice President (“VP”) of Clinical Operations and assists in the overall management of Risk operations for the Market. Serves as a corporate-level manager for the Clinic Operations Administrators and other Market leadership support and is a liaison between the Corporate office for various operational elements within the Market. Assists Clinical Operations VP in coordinating activities of new center start up and development, as well as the integration activities for newly acquired centers, ongoing daily operations for established centers and the IPA Network. Shares accountability for delivering on service excellence and member retention. Shares accountability for achievement of quality and financial goals for the Market.Major Responsibilities
- Assist the VP in the development, coordination, and implementation of the regional budget, business plans, and operational activities.
- Work closely with appropriate company resources to monitor and report metrics such as resource utilization, patient satisfaction, and other key performance indicators, and initiate organizational and system changes enact plans to improve efficiencies and reduce expenses.
- Work closely with appropriate company resources to enhance Provider satisfaction, productivity, and performance.
- With the VP, work closely with corporate departments to ensure that issues impacting the region involving corporate departments are resolved effectively and timely.
- Assists in identifying opportunities for improvement within the Market’s clinics and present proposals incorporating solutions.
- With the VP, collaborate with the physician leadership team of the region to garner support for operational initiatives and obtain feedback as to what initiatives will be most successful.
- Assist, facilitate, and lead committees, teams and projects at the direction of the VP.
- Facilitate temporary agency negotiations, monitor and track usage, and develop monthly spreadsheets for tracking and recommendations.
- Communicate with VP regarding risk management issues and participate in the resolution of issues as necessary/requested.
- Identify need for and participates in the development and implementation of care management and utilization management policies and procedures, and ensure compliance throughout the region and consistency throughout the network.
- Monitor provider referral patterns for appropriate utilization of specialty and ancillary services.
- Oversee the triage process.
- Work with other third party organizations such as health plans to resolve operational issues.
- Assist Network Management in contracting of specialists in the Market.
- Ensure compliance with Company Healthcare Policies & Procedures and state and federal regulations/standards.
- Ability to travel required. Valid driver’s license, insurance, and vehicle for needed for work-related travel.
- Coordinate or perform projects/activities as delegated by organizational committees and VP.
QualificationsKnowledge / Skills / Abilities:
- Excellent planning and organization, critical thinking, and decision-making skills.
- Result oriented with proven leadership and staff development skills.
- Sound business acumen.
- Excellent written and verbal communications skills; Able to communicate effectively with team members and leaders at all levels, with physicians, and with various categories of customers.
- Work cooperatively and collaboratively with peers and subordinates.
- Sound negotiation and conflict resolution skills.
- Project management skills with the ability to multi-task, set priorities and accomplish assignments.
- Knowledge and experience in data analysis, financial analysis, and medical review.
- Work effectively with analytical tools, spreadsheets, and instructional tools.
- Knowledge and experience in quality assessment and improvement programs.
- Knowledge and experience in the development and administration of managed care principles and practices.
- Develop, implement, and monitor processes to effectively uphold standards of care, policies and procedures.
- Computer literate; Proficient in Microsoft Office applications.
- Minimum: At least 7 years of health care experience to include at least 4 years in healthcare management.
- Preferred: Prior ambulatory care and/or primary care experience.
- Preferred: Experience in a medical group, IPA or HMO setting.
- Preferred: Prior multi-site management experience.
- Preferred: Experience with Lean Management.
- Minimum: Bachelor’s degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college.
- Preferred: Master’s Degree, MBA