Director, Consumer Direct Job in Owings Mills 21117, Maryland Us

Job Description:
THE IDEAL CANDIDATE WOULD COME FROM HEALTH CARE AND KNOW THE INS AND OUT OF HEALTHCARE REFORM:
THE POSITION IS AS FOLLOWS.

Program Director, MHIP
Consumer Direct Administrative Services Unit

Job# 4373

Location – Red Run – Owings Mills, MD

Position Overview:
The position of Program Director for the Maryland Health Insurance Plan (MHIP) is of strategic importance to the CLIENT organization. The account is a state organization and is a prestigious customer with high visibility that requires outstanding service delivery and the ability to effectively manage better health outcomes amongst its members. As the High Risk Pool for the State of Maryland, MHIP members in general are faced with significant health and financial challenges. This position will be directly accountable for all of the operational functions required to MHIP including Claims, Service, and Enrollment as well as organizational oversight for functions which directly impact the program. Additionally, the individual filling the role will be the key strategic leader and driver for implementing CLIENT’s Primary Care Medical Home model and the Healthy Blue product portfolio for the MHIP account. This position will work directly for the Senior Vice President (SVP) of the Consumer Direct ASU and with the CLIENT CEO in designing and directing efforts that will deliver more effective and efficient cost of care outcomes for MHIP. Additionally the individual will actively develop and promote the implementation of strategies and tactics for the continuous improvement of systems, processes, and people to cultivate a high performing operation.
This position will direct end-to-end operational functions, including Claims, Service and Enrollment, to service the MHIP account with optimum efficiency, quality, timeliness and accuracy to achieve all internal and external corporate goals and objectives, while providing support to all internal areas as needed. This position serves as the relationship manager with senior executive management both internally and externally, including the CEO, SVP, Healthcare Analytics, and key regulatory and legislative personnel.
PRINCIPAL ACCOUNTABILITIES: Under the direction of the SVP of the Consumer Direct ASU the principle duties and responsibilities include, but are not limited to, the following: Function as the CLIENT relationship manager and liaison with internal and external stakeholders. Keep aware of external environment, with acute focus on healthcare reform, and facilitate public relations in support of CLIENT MHIP product programs. Design, develop, plan and prioritize operational functions to meet overall strategic goals and objectives with focus on multi-state preparedness and consumerism as it relates to the future health exchange driven market. Ensure that the ASU successfully connects to and succeeds on the VA, MD, and DC Exchanges and influences policymaking as it relates to the organizational impacts.
Direct the activities of the MHIP Claims, Service, and Enrollment departments by reviewing and analyzing claims inventories, timeliness, accuracy, productivity, cost appeals, complaint reports or equivalent enrollment/customer service data to strategically determine the allocation of staff, training needs, and improve current process to consistently exceed all performance expectations. Responsible for identifying and resolving corporate issues involving respective departments. The position ensures the attainment of goals by developing, approving and implementing operational strategies, plans and objectives, monitoring and ensuring the efficiency and effectiveness of the operation, evaluating work flows, procedures, policies and staffing needs, and always adhering to external, corporate and customer/provider standards for quality, timeliness and accuracy.
Responsible for associate development and performance management of managers and other staff reporting to this position. Accountable to drive the performance assessment of all direct and indirect reports.
Participates in corporate operations projects in order to achieve and maintain efficiency and quality standards. Drives implementation of better operational capabilities for the MHIP account
SUPERVISORY RESPONSIBILITY: Leads a multifunctional team of 30+ associates. Direct reports can include, but are not limited to, Operations Managers, Account Management and non-management staff such as Administrative Assistants, Business Analysts and Reporting Analysts. Provides oversight of approximately 20+ indirect reports and 5+ direct reports. Position requires very strong verbal and written communication skills as the leader will interact with the CLIENT Executive team and key State officials.
Qualifications and Requirements:
Required: Bachelor’s Degree in business or related area and 10+ years of senior management experience in a customer service, claims and/or enrollment and billing related discipline. Extensive knowledge of health insurance payment models and plan designs. Knowledgeable of healthcare reform legislation. Call Center Experience, including knowledge of state of the art technology. Proven management and leadership experience is critical. Demonstrated skills in successful interactions with high level executives and stakeholders.
Abilities/Skills: This position requires senior-level management skills including the ability to lead far-reaching/transformational initiatives on behalf of the company. Must possess “big picture thinking” in addition to excellent associate management, project management, financial planning and risk analysis skills. The individual must have extremely strong analytical and problem solving skills, and the ability to develop and implement policies and programs that will advance corporate and operational goals and objectives. Excellent planning, negotiation, and presentation skills. Excellent interpersonal skills, the ability to effectively manage a staff through leadership and the promotion of teamwork is essential. The incumbent must possess excellent interpersonal skills and highly developed written and oral communication skills to effectively convey complex and detailed concepts to a diverse audience, including senior level stakeholders. The incumbent must possess extremely well developed organizational and prioritization skills.
Preferred: Master’s degree preferred, with key understanding of Healthcare payment models and Federal Reform.
EEO Statement
We are an Equal Employment Opportunity/Affirmative Action Employer and ADA compliant

Job Experience:
This is a senior level position requiring a fair amount of visibility and exposure and serves as a key relationship manager with internal and external stake holders, the CEO as well as regulatory and legislative personnell. Prior experience directing claims, service and enrollment is highly preferred as well.
Please send resume in MS WORD as an attachment to sybil.kalu@adeccona.com 703-885-5591 (Direct Line).

Minimum Education Required: Masters

Years of Experience Required: More than 5 years

Expected Travel Time: About 25%