CareFirst Careers

CF Comm. Health Plan DC, COO (DC Medicaid)

Resp & Qualifications

POSITION OVERVIEW

The Chief Operating Officer (Community Health Plan - DC Medicaid) is responsible for management and administration of multiple functions and general business operations, claims, information system conversions, call center performance guarantees, state reporting, provider network strategy, and appeals & grievances. This role provides subject matter expertise in project management, project scope definition, risk identification, project methodology, resource allocation and other areas of expertise. The Chief Operating Officer is also responsible for provider value-based contract oversight, meeting with providers individually as well as joint operating committees; relationship management (behavioral health, Rx, payment integrity, dental, vision, analytics); and the design, coordination and completion of operational improvement projects across various functional areas, will review the various departments’ performance and effect change as needed to improve service, simplify work flow and assure compliance with regulatory requirements.

 

POSITION DUTIES AND RESPONSIBILITIES

• Plans/implements and manages operations programs and strategies

• Supports, develops and validates compliance with operations policies, procedures and regulations

• Reviews, manages and drives operations efficiency, quality and financial performance

• Sets business direction, develops, implements and oversees operational models to meet the unique needs and business requirements

• Verifies improvements and operations are evaluated based upon appropriate quantitative and qualitative measures

• Develops collaborative relationships with and confirms business partners can execute day-to-day responsibility for operations (member services center,

enrollment, technology, network, etc.)

• Informs and advises management regarding State/District current trends, problems and activities to facilitate both short- and long-range strategic plans to improve operational performance and enhance growth

• Confirms all operational activities conform to contract compliance for all programs

• Sets business direction, develops, implements and oversees operational models to meet the unique needs and business requirements for THP

• Confirms operations and service models are optimized

• Develops collaborative relationships with and confirms business partners can execute day-to-day responsibility for operations (member services center, enrollment, technology, etc.)

• Develops collaborative relationships across multiple service offerings

• Informs and advises management regarding State’s current trends, problems and activities to facilitate both short- and long-range strategic plans to improve operational performance and enhance growth

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

• Owns accountability for state reporting metrics, accuracy, and timeliness

• Identifies and resolves technical, operational and organizational problems inside and outside health plan

• Understands and manages the State requirements and relationship related to operations

• Provides governance on network strategy and development

• Directs others to resolve business problems that affect multiple functions or disciplines

 

QUALIFICATIONS

• Bachelor’s degree in Healthcare Administration, Business, or Management, MBA preferred

• Three years working in a matrix organization

• Knowledge of and experience related to publicly funded government health care programs (e.g., Medicaid, Medicare or State health care programs for the uninsured)

• Technical and financial understanding of health care operations

• Ability to advise IT resources related to enterprise platform initiatives; provides direction on platform migration

• Experience, aptitude, and effectiveness in matrix environment

• Working knowledge of relevant federal and state regulations and requirements

• In depth understanding of challenges that face health plans and health care in general

• Seven years of people management experience required Knowledge of and experience related to publicly funded government health care programs (e.g., Medicaid, Medicare or State/District health care programs for the uninsured

• Operations experience in Medicaid/Medicare/government health care program administration

• Strong leadership and business planning skills within a matrix environment

• Ability to communicate clearly with internal partners and external regulatory agencies

 

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 3.20.21

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

Learn more about Business Operations