Description
THE ROLE
Provides operational leadership, management and direction for all Customer Service teams, including but not limited to member and provider call support, customer service team support, training, documentation, analysis, auditing, call coaching, and appeals and grievance. It may also include responsibility for managing a key vendor/partner relationships, including negotiations and contracting. Product lines include Medicare, Medicaid, commercial group, commercial ASO, and individual plans. Primary membership base is in Oregon and Southwest Washington, although PHP also has large ASO clients in Washington, California, Montana and Alaska. This position holds primary accountability for overall performance of the above functions for a growing client base in a manner consistent with the strategic direction of Providence St Joseph Health.
MAJOR CHALLENGES:
The primary challenge facing the Senior Director, Customer Service revolves around effective operations of assigned teams to ensure performance meets PHP strategic initiatives, group retention, member loyalty and fiscal stewardship. Responding to member & provider inquiries, requires a constant need for increased efficiency and automation, which presents a challenge in the light of increasing complexity of products, plans and regulations. This includes developing policies, practices, procedures and processes as well as keeping abreast of industry trends and innovations.
This position is a primary contact between PHP's Operations and IS departments. Information and data are the core of operations and as such, effective and efficient IS interfaces are critical. Also, as administrative costs become a critical factor in Health Plan's success, the link with IT/IS for technology assistance is vital as a method of reducing and managing costs.
The health plan world becomes more complex each year, and it is necessary constantly to monitor organization structure, tools, training, employee satisfaction and workplace culture. Significant flexibility is required in this position, as assignments and priorities may change with little notice.
Incumbent must envision and project the future consistent with Providence St. Joseph Health for the Health Plans in planning strategies, integration, growth, and continued success in the commercial self-funded, and government market.
Incumbent must provide leadership for success of the Health Plans Operations while continuously scanning the landscape for best practices that would further enhance efficiency and service.
Incumbent must maintain established service levels in an environment with regular staff turnover/ turn up.
ESSENTIAL FUNCTIONS
Responsible for the overall service quality and effectiveness of services provided throughout Health Plans operations. Assures the proper management, utilization, and enhancement of all resources, tangible and intangible.
Provides strategic leadership to assigned operating units in a way that optimize quality, cost effectiveness, competitive edge, and responsiveness.
Serves as a liaison between PHP Operations and PHP Information Services for all production, technology assessment & planning, vendor analysis, as well as development and project work. Supports Agile processes including sponsorship and oversight as appropriate.
Develops standards, policies, and performance objectives for assigned Operations departments.
Strives towards excellence in the attraction and development of Health Plan Operations professionals. Selects and develops leaders who will meet the qualitative, quantitative, and mission related goals of this area of responsibility. Provides leadership, encouragement, and support to all Health Plan personnel by maintaining high standards of performance and delivery of service.
Responsible for preparing and maintaining assigned portion of Operations strategic plan, including the annual budget; has major responsibility for optimizing productivity and cost effectiveness throughout the operations and for identifying and monitoring key success measures.
Develops and monitors Operations organizational structure, including the delegation of duties and organizational development of key staff. Fosters team work and creates a culture of employee empowerment.
Monitors staff training and performance for assigned departments, including new employee training as well as a comprehensive program designed to cross train employees in all functional areas.
Maintains knowledge of the market throughout the Northwest and the PSJH Regions.
Provides the vision and leadership necessary to establish future directions, develop appropriate strategies, and direct their implementation for the operations of the health plans.
Establishes positive working relationships with physicians, vendors and other business entities throughout Providence Health & Services.
Represents PHP Operations and services to clients, potential clients, consultants and other community constituents in an appropriate manner as opportunities arise.
Keeps abreast of, and recommends to senior management, the latest technology improvements in telephony services, customer service, digital platforms, workforce management applications linkages, and core operational procedures.
Responsible for identifying key capital needs for PHP Service Operations.
In conjunction with Information Services & Planning, evaluates and prioritizes key work projects and monitors progress while managing the utilization of scarce resources.
Oversight of Appeal and Grievance activities.
As needed, assumes DRI (Direct Responsible Individual) role for projects and other relationships and initiatives.
IDEAL QUALIFICATIONS
Required experience/education for this position include:
Bachelor's Degree in Healthcare Administration, Business Administration or other related field.
10 or more years of Experience in health plan operations
5 years in a senior Management role (Director level)
A track record showing the ability to effectively communicate organizational planning as well as effectively develop and meet budget requirements
A deep understanding of all Health Plan Functions and successful application of project management skills, performance management skills and techniques, and demonstrated use of continuous quality and efficiency improvement tools
A deep demonstrated understanding of all Health Plan offered products and services
Demonstrated strong interpersonal skills internally within area of direct responsibility as well as all other areas within Service Operations, PHP, and PSJH as a whole
Demonstration of strong team building skills and shown persuasive communication abilities
Must be able to demonstrate the ability to work within team settings to enhance shared leadership philosophies, and to inspire and motivate managers to create and lead strong teams
Must demonstrate innovative improvements to existing processes to create efficiencies
Must be able to show an understanding of the importance and impact of quality initiatives to PHP - such as NCQA, HEDIS, and Medicare Five Star - and demonstrate support and improvement where needed
Must have an understanding of phone and workflow related technologies with proven ability to make needed changes to improve quality and efficiency.
Preferred experience/education for this position include:
- Master's Degree in Healthcare Administration, Business Administration or other related field.
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: 116663
Company: Providence Jobs
Job Category: Member Services Enrollment & Billing
Job Function: Health Plans Services
Job Schedule: Full time
Job Shift: Day
Career Track: Leadership
Department: 5018 OPS PHP CSO OR REGION
Address: OR Beaverton 3601 SW Murray Blvd
Pay Range: $66.13 - $115.64
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.
Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
