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VP of Operations

Job Summary: The Vice President of Operations leads and manages Prominence’s Operations consistent with the strategic goals of Prominence Health Plan. This position is a key part of Prominence’s strategic imperative to achieve its financial performance goals, as well as its goal of building the capacity necessary to support UHS’s clinical integration strategy. The incumbent will take direct responsibility for Prominence Operations with Enrollment, Claims, and Customer Service. The incumbent will likely be responsible for all current lines of business and future lines of business including Medicare Advantage, Commercial, and ASO/Self-Funded. As a member of Prominence’s senior leadership team, the incumbent will be accountable with other senior leaders for achieving Prominence’s financial, quality, and service goals. In addition, the incumbent will represent Prominence in UHS workgroups working on clinical integration and population management.
Requirements:
Education and Experience:
• Bachelor’s Degree in Business or related Health Care degree, or Master’s in Public Health or MBA.
• At least eight years of Operations management or consulting experience with at least three year experience in managed care.

Commercial specific:
• Experience with optimizing revenue cycle from rate development to billing and collection
• Experience with optimizing benefit administration cycle from benefit design to provider contracts and claims
• Experience with provider networks from reimbursement models (including P4P and capitation) to contracting and their impact on operations

Third Party Administration specific:
• Experience with self-funded groups from benefit design to reinsurance contracts to client reports

Medicare Advantage specific:
• Experience with multi-State Medicare Advantage program
• Experience with CMS at the strategic and tactical level
• Experience with delegated entities
• Strong coordination capabilities to direct and supervise the intersections of Prominence functional areas and delegated entities
• Capability to build in-house infrastructure to allow outsourced functions being moved in-house
• Experience to work collaboratively with Compliance
• Detailed understanding of the bid submission process
• Detailed understanding of the risk score collection and documentation process
• Detailed understanding of the Star rating process and demonstrated ability to move Plan toward a 5 star rating

Skills:
• Strong communication, influencing, presentation, and relationship building skills
• Proficient in Microsoft Office Suite
• Strategic but practical thinker that can take concepts from its initial stage through implementation to administration
• Excellent communicator who is equally comfortable with external stakeholders as well as internal stakeholders
• Demonstrated ability to build a highly functioning team and to mentor direct reports
• Experience with Commercial, Self-funded, and Medicare Advantage network requirements
• Proven ability to foster collaboration between divergent stakeholders
• High degree of credibility with key stakeholders based on past accomplishments
• Experience in negotiating complex provider reimbursement arrangement and complex third party contracts
• Adept in managing outsourced vendor relationships in compliance with NCQA and CMS delegated entity rules
• Comfortable in managing interfaces with Prominence functional areas and third party partners
• Proven ability to drive organization through cultural change, focused on individual accountability and performance
• Solid understanding of health plan key financial drivers
• Service excellence orientation toward external and internal stakeholders

Time:  Full time
Salary:  Salary
Category:  Administration

Updated: 11/12/2018 1:24:34 PM