Mgr Business Operations

Position: Mgr Business Operations

Job ID: 143839

Location: US-TX-Houston


Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a-5p

About Texas Children's Hospital

Nation’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 Manager, Business Operations someone who works well in a fast-paced insurance plan setting. In this position, you will work collaboratively with the director to further refine the structure for health plan operations and identify additional resource needs. This role will work closely with other department leaders to facilitate day-to-day cross-departmental health plan operations, interact with the leadership team to translate the business/operational needs for communication with the organization’s IT partners, and partner with IT to evaluate the outcomes of enabled technology against the business rules/requirements. 


Responsibilities :


  • Partners with health plan department leaders to make operations recommendations regarding various functional areas of the health plan. Functional areas may include, but not limited to benefits management, enrollment, claims processing, and call center operations 
  • Works collaboratively with others across departments to assess the impact on health plan operations of new rules and regulations and/or respond to newly released federal, state, or other regulatory requirements 
  • Assesses processes and workflows across functional areas and makes recommendations on solutions that will create efficiencies in operations 
  • Reviews annual departmental plans to assess for overlapping priorities and cross-departmental dependencies 
  • Communicates analysis to all stakeholders and work collaboratively with others to devise plans that minimizes disruption to current health plan operations while driving towards outcomes that promote seamless operations. Facilitates the implementation of such plans and reports outcomes 
  • Works collaboratively with others, including IS to drive excellence in the care delivery experience for members and providers across the continuum 
  • Facilitates change to enhance the member and provider experience as needed. Assess the change impact on operations and suggest modifications as warranted 
  • Participates in various committees and workgroups as warranted to provide guidance/input into the operational issues presented 


· A Bachelor’s degree in Healthcare Administration, Business Administration, or related field

· Four (4) years of experience in health plan operations

· Three (3) years of management/leadership experience is preferred

· Lean Six Sigma certification is preferred

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