Operations and Capability Program Manager

Under the direction of the health plan executive team, this position supports the alignment, accountability, operational improvements, and strategic initiatives across the health plan. The role involves analyzing and reporting data on operational performance, conducting root cause analyses, and developing procedures for improved performance. Additionally, this position will participate in policy development, lead process improvement initiatives, and create educational materials for staff, members, and network providers.

The incumbent will play a crucial role in identifying root causes of issues impacting the member and provider experience and organizing data collection to facilitate process improvement. This position works closely with health plan leaders to identify and address operational issues and supports the implementation of proposed solutions to enhance the members experience this includes researching and identifying problems and facilitating adjustments to enhance operational excellence. The incumbent will support operational initiatives through the development and management of project plans and ensure that deadlines are met. This position will also assist with the planning, synchronization, and execution of new business and ensure operational processes provide a superb member experience.

The essential functions of the position are:

· Identify root causes of operational inefficiencies and facilitate adjustments to enhance member and provider experiences. This includes researching and identifying problems and facilitating process improvement for operational excellence

· Cultivate internal relationships across the health system to gain insight on barriers and issues

· Perform analysis of workflows, data collection, report details, and other technical issues associated with assigned initiatives with some supervision

· Monitor administrative errors to improve workflow efficiency, as well as conduct root cause analysis to determine performance issues

· Mentor staff involved in improvement efforts, providing strategies for adhering to project timelines, and review initiative results with team members to highlight their impact

· Collaborate and assist with education to stakeholders to increase engagement on all health plan performance initiatives that support regulatory requirements for programs such as HEDIS, NCQA, CAHPS, and Star Ratings

· Assist in the education of new policies and procedures designed to enhance quality care and minimize member, customer, and provider disruption

· Coordinate operational acceptance of improvements or changes to ensure accuracy, quality, and timeliness of implementation to existing operational systems, processes, or partners

· Continuously improve and optimize the function by monitoring performance, steadily raising expectations, and adjusting the organization and business processes to achieve results

· Establish communication processes to keep leadership informed with detailed and accurate updates

Essential to success in this role:

· Strong understanding of the business and operational aspects of a health plan

· Ability to maintain effective working relationships with internal staff, physicians, other providers, staff, employers, regulatory agencies, and enrollees

· Simultaneous action at varying stages—initiation, follow-through, and completion—on multiple different projects

· Resourceful, detail-oriented, and able to assimilate and analyze a wide variety of information, often working under deadline pressure with a variety of levels of staff

· Ability to review, analyze, and interpret regulatory requirements in a clear and concise manner

· Excellent data gathering and analysis capabilities

· Ability to design and develop reports, documents, and spreadsheets for an executive audience

· Ability to work independently, achieve deadlines, and take initiative on multiple projects

· Proven positive track record in organization-wide transformation and scaling

· Experience facilitating process improvement events

· A willingness to learn and be curious

· Excellent collaboration, influencing, prioritization, and time management skills

This position does not provide patient care.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Name

Description

Education:

Must have working-level knowledge of the English language, including reading, writing, and speaking English. Bachelor’s degree in business management, operations, healthcare, public health, IT or related field required or equivalent combination of education, training, and experience.

Experience:

Minimum five years’ experience in the health insurance industry or health care. Experience with Medicare Advantage plans or Medicare Managed Care preferred. Minimum five years’ experience in operations discipline, experience in manufacturing and/or technology industries preferred.

License(s):

None

Certification(s):

Project Management Professional (PMP) certification Preferred

Computer / Typing:

Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Typing 35 WPM.