Chief Operating Officer

Under direction from the Chief Executive Officer (CEO), the Chief Operating Officer provides overall management and oversight of Member Services, Claims Management, Provider Services and the management of outsourced services. This position has overall responsibility for policy development, program planning, fiscal management, administration and operation of assigned Plan functions, programs and activities; partners with IT as well as ensures all related regulatory requirements are met. The position assists the CEO in implementing the organization’s strategic goals, vision and mission and will play a key role in ensuring high quality health outcomes to members.

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 Statement(s):

  • Operate with sensitivity to the County Organized Health System (COHS) model of managed care that Ventura County has established for the community.
  • Manage outsourced vendor providing claims, customer service, IT and other related work, including contract negotiations and oversight of deliverables.
  • Oversee provider contracting and provider relations functions with sensitivity to the characteristics of the COHS model.
  • Responsible for claims, provider contracting and provider relations, and member services.
  • Develop an administrative plan and procedures to insure clearly defined lines of responsibility, equitable workloads and adequate supervision.
  • Promote a collaborative, proactive, problem solving environment across departments and within operations.
  • Ensure that all eligible members are loaded in the system to prevent any potential delay in care.
  • Manages budgets of assigned departments and ensure compliance of each area with current state and federal laws and regulations.
  • Initiate, implement and review activities to advance quality, improve member, provider and employee satisfaction, reduce expenses and increase staff productivity.
  • Responsible for reporting and analysis in achievement of department goals.
  • 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 to relevant stakeholders.
  • Participate in the implementation of the plan-to-plan agreement with AmericasHealth Plan.
  • Participate in the evaluation of new technologies and support system implementations.
  • Fills in for CEO at the CEO’s discretion.

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.
  • Financial Aptitude – Ability to understand and explain economic and accounting information, prepare and manage budgets, and make sound long-term investment decisions.
  • Goal Oriented – Ability to focus on a goal and obtain a pre-determined result.
  • Relationship Building – Ability to effectively build relationships with customers and co-workers.
  • 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 from an accredited university is required, field of study: in an appropriate discipline. Master’s Degree preferred, field of study: business, healthcare or public administration is preferred.
  • Any combination of experience and training that would provide the required knowledge, skills and abilities would be qualifying.
Experience:
  • 10 plus years of experience in senior-level positions in the healthcare field.
  • Extensive experience in a health plan environment, strong understanding of managed care, demonstrated knowledge and experience in health plan operations in the areas of Member Services, Claims Management, Provider Services, Vendor Management and Outsourced Services.
  • Experience with Medicaid and knowledge of government health care programs is strongly preferred.
  • Experience operating within a public agency, working with and presenting to a governing board or Commission; knowledge of Brown Act requirements recommended.
  • Proven track record of managing and mentoring high performing teams.
  • Experience implementing a long-term strategic plan.
Computer Skills:
  • Proficiency with the programs included in the MS Office.
Licenses:
  • A valid California driver’s license
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