Gold Coast Health Plan will not sponsor applicants for work visas.
The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.
POSITION SUMMARY
The Director, Operations, in collaboration with the Executive Director of Operations Officer, is responsible for the strategic direction and management of daily operations for Oversight, PDRs, Joint Operations Meetings (JOMs), JQRs, Regulatory Reporting, and the management of various outsourced services, including but not limited to, mail room processing and recoveries. The successful candidate will assist in implementing the organization’s strategic goals, by directing the implementation of new programs and systems, developing, and maintaining policies and procedures and ensuring regulatory/contractual compliance.
This position plays a key leadership role, interacting with all levels of Gold Coast Health Plan (GCHP) staff and external stakeholders, including the Ventura County Medi-Cal Managed Care Commission, executive staff, members, providers, network management, legal counsel, State and Federal representatives and representatives of other agencies.
Distinguishing Characteristics: Responsible for overall policy development, program planning, fiscal management, administration, and operation of assigned Plan functions, programs, and activities. The Director of Operations is responsible for accomplishing goals and objectives and for ensuring that the area served is provided with desired and mandated services in an efficient and effective manner.
Work Schedule: Work protracted and irregular hours and evening meetings or work unusual hours for meeting attendance or participation in specific projects or programs.
Amount of Travel Required: 30%
ESSENTIAL FUNCTIONS
Reasonable Accommodations Statement
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.
Essential Functions Statements
• Responsible for strategic direction and daily management of key operations areas - Vendor Management, Mail Room, Encounter Processing, Recoveries and ensures the development and management of performance measurement, management controls, critical success factors and key performance indicators.
• Vendor Management is a key responsibility of this position. The candidate will be expected to become familiar with all aspects of the outsourcing contracts and manage the GCHP vendor partners ensuring that all operational functions are managed in accordance with contract terms, regulatory requirements, and industry standards.
• Establish and ensure adherence to Medi-Cal and GCHP policies and procedures for all functional areas of responsibility.
• Work with the Executive Leader to develop plans for systems and staffing to meet current and future programs, requirements, and initiatives.
• Reviews plans and budgets of assigned departments monthly and as part of the annual planning process.
• Facilitate data-driven decision making across operational areas that leads to meaningful actions.
• Implement new initiatives and resolve problems that cross multiple departments by forming ad-hoc workgroups and assessing intangible variables, automated processes, manual workflows, and impact to providers and members.
• Work closely with staff, vendors, and peers to set goals, clearly define operations, and develop appropriate performance standards, metrics and reporting tools.
• Oversee the integration of operational departments to maximize the effective use of all resources towards meeting established goals, compliance and quality requirements, and policies and procedures.
• Develops and maintains policies and procedures to meet goals and ensure regulatory/contractual compliance; collaborates in managing regulatory audits and inquiries.
• Serves as the agency authority on Operations Oversight, Operational Analytics and/or Joint Operating Meetings
• Develop and direct supervisory development and training, including continuous improvement of knowledge and skill levels of all assigned staff
• Collaborate with internal and external customers and stakeholders to resolve issues and enhance relationships. Ensures the organization and its mission, programs, products and services are consistently presented in a strong, positive image.
POSITION QUALIFICATIONS
Competency Statements
• Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.
• Management Skills - Ability to organize and direct oneself and effectively supervise others.
• Business Acumen - Ability to grasp and understand business concepts and issues.
• Decision Making - Ability to make critical decisions while following company procedures.
• Presentation Skills - Ability to effectively present information publicly.
• Negotiation Skills - Ability to reach outcomes that gain the support and acceptance of all parties.
• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
SKILLS & ABILITIES
Education:
• Bachelor’s degree (four-year college or technical school) Preferred not required, Field of Study: Business, Health Care or Public Administration or Equivalent Work Experience
• Previous experience dealing with Government programs, both Medicaid and Medicare. Knowledge of Managed Care, particularly Medi-Cal, is desired: or Work Equivalent
Experience: 7 plus years of experience in Operations Management
Computer Skills: Advanced computer skills included in MS Office products.
Certifications & Licenses: A current valid California driver's license.
Other Requirements:
• Business principles and techniques of administration, organization, and management to include an in-depth understanding of the key business issues that exist in the health care industry.
• Communicate effectively in writing, orally, and with others to convey information, in a manner consistent with job functions.
