VP Health Plan Operations

VP Health Plan Operations

www.myrecruiting.biz, the premier source for specialized Health Management recruitment in Texas, Louisiana and the Gulf South, is currently seeking VP Health Plan Operations for a Direct Hire opportunity in New Orleans, LA. Our client company has a long term growth plans for this Health Care firm and is seeking only the most talented and driven professional to join their team.
Summary:

Assists the Health Plan President and CEO in the fiscal and operational management of the Health Plan. Serves as the liaison to all Virginia Beach support services. Have local responsibility for network development, provider partnerships, provider relations, and quality management programs, performance management/improvement, budgets, complaints and appeals, monthly financials, and reporting. Responsible for identifying, developing and implementing best practices and coordinating implementation of Health Plan initiatives. Work collaboratively with Health Plan Services, HP SME?s and Home Office SME?s.

Responsibilities:
1. Establish objectives and annual goals in conjunction with the Health Plan CEO/COO, Health Plan Operations, and key initiatives.
2. Facilitate Plan requirements with Corporate initiatives; promote Plan concerns and enhance communications between respective business owners.
3. Analyze, evaluate and implement best practices.
4. Support Plan Executive Management teams by monitoring plan performance; analyze for gaps and opportunities for OpEx.
5. Manage assigned projects including the development of business processes, workflows and training programs to assist the Health Plans in improving their Operational Excellence.
6. Provide leadership for Health Plan Operational Excellence programs.
7. Develop and implement tools for monitoring and evaluating performance objectives.
8. Coordinate implementation of Health Plan initiatives.
9. Recognizes and utilizes appropriate channels for communication, encourages two-way communication with Plan and Home Office staff to participate in creative program development resulting in improved efficiency and enhanced job performance.
10. Serves as the liaison to all support services, Claims, Enrollment, MPS, Finance, Business Control, Med/Finance, Regulatory Compliance, IT, etc., in Virginia Beach. Participates in cross-company operational activities on an ad hoc (e.g., Service Center Audits) and ongoing (e.g., MOR; QOR) basis.
11. Develops and manages provider contracts and partnerships to achieve quality, cost management, and strategic business development objectives; develops and negotiates strategic provider contracts on behalf of the Plan.
12. Responsible for and leads the Plans performance management/earnings improvement activities. Assists in developing policy and programs to achieve business results through effective financial management.
13. Assists CEO with development of the Plan?s annual administrative, medical, and capital budget process.
14. Assists CEO with management of monthly reporting and review of financials/accruals.
15. Appeals Grievances: Responsible for the Plan?s complaint, appeals, pended claims, and claims research functions.
16. Other Duties as Assigned.


Qualifications:

EDUCATION:
Required: Bachelors degree in Accounting, Finance or Business.
Preferred: Advanced Degree in a related field.


EXPERIENCE:
Required:
· Ten years of in-depth experience in the HMO/healthcare field.
· Five years project management/program implementation experience in the Health Plan environments.
· Five years of successful management experience.
If you are in search of a challenging position as VP Health Plan Operations or know someone who would be interested in this, please contact Lee Youngblood at (832) 242-9408, or e-mail your resume to lee-resumes@myrecruiting.biz for confidential consideration.
Go online for more details on the VP Health Plan Operations position, or visit our website http://www.myrecruiting.biz for more job offerings.
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McIntyre Youngblood Recruiting, LLC, www.myrecruiting.biz is an equal opportunity employer specializing in direct hire employment and temporary staffing of accounting, finance, legal, administrative and information technology (IT) professionals in Houston, Dallas and New Orleans. With 30 plus years of experience we are able to provide experienced candidates at all levels including management consulting. MYRecruiting is a certified Woman Owned Business Enterprise (WBE) and HUB qualified. McIntyre Youngblood Recruiting, LLC was named to Louisiana?s Top Business List for 2008 and 2011 by www.DiversityBusiness.com as a top emerging business.

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