About Texas Children's HospitalNation’s 1st Pediatric HMO 3rd Largest Medicaid plan in Texas with more than 430,000 members Affiliation with Texas Children’s; ranked 4th on 2017 U.S. News and World Report survey of Best Children’s Hospitals Owns and operates two community based Patient Centered Medical Homes Is a STAR Kids program provider for children with medical complexities
We are searching for a Director, Business Operations – someone who is visionary and innovative and who works well in a thriving health plan setting. In this position, you will be responsible for helping to further define and enhance the structure for health plan operations; the growth of Texas Children’s Health Plan has made it necessary to develop this strategic role occupied by someone with excellent command of health plan operations. This role will be considered the subject matter expert regarding health plan operations and his or her contributions are needed to help create successes for the Health Plan today and in the future.
· Through engaging partnerships and collaboration, the person in this role will assist the health plan with creating excellent member and provider experiences along with developing and executing strategies that will have a positive effect on the health plan’s margin
· Will work closely with the department’s executive to provide leadership, oversight, and direction for the health plan’s operations
· Work cross-departmentally with health plan leaders to facilitate decision-making regarding various functional areas, e.g. benefits management, enrollment, claims processing, call center operation, etc.
· Partner with IT to ensure systems and technology is enabled that meets the requirement for the organization
· Assists leaders with the development and implementation of policies, procedures, and guidelines to drive compliance with federal and state guidelines
· Conducts periodic evaluation of operational processes to ensure compliance is maintained
· Provides metrics and reports to monitor and track the status of operations
· Collaborates with leaders and others within the Health Plan and Texas Children’s regarding cost of care initiatives and/or other strategies to be implemented across the system
· A Master’s degree in Healthcare Administration, Business Administration, or related field
· Eight (8) years of experience in health plan operations, including (4) years of management/leadership experience
· Experience in strategic planning and development and implementation of process improvement strategies across multiple areas is preferred
· Lean Six Sigma certification is preferred
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