SC Medicaid Market Director

Profile

Description

The Director, Market Leadership (COO) establishes long-range goals, objectives, and plans; monitors financial and operational performance. He/she will be responsible for the strategic development and oversight of operations for Humana's South Carolina Medicaid plan. They will manage ongoing operations across multiple levels of the organization to meet operational contract requirements and financial performance goals. They will be accountable for operational results. Represents the health plan externally and to governmental/external agencies.

Responsibilities

Direct and coordinate day-to-day plan functions, including reporting, claims administration, encounter data quality, grievances and appeals, information technology and systems, program integrity and regulatory compliance, member services, provider services, and business continuity planning and emergency coordination

Liaise between the South Carolina Department of Medicaid (SCDHSS), plan leadership, and corporate contacts responsible for the execution of contract deliverables

Work with the plan CEO to maintain important stakeholder relationships throughout South Carolina

Lead internal infrastructure to review and improve operational functions

Manage implementation of strategic plans developed in cooperation with the plan CEO

Oversee development and maintenance of operational policies and procedures

Effectively implement business plans and oversee audit processes

Own execution of daily operating objectives and goals, including key performance metrics

Plan organizational growth and potential staff successions

Develop and cultivate a diverse and inclusive environment

Maintain intimate familiarity with contractual requirements and stipulations

Understand and actively manage ongoing adherence to local, state, and federal regulatory and programmatic requirements

Mitigate risks potentially impacting the state of South Carolina and the plan by proactively monitoring any risk factors and red flags that may arise during operations

Communicate with ODM and direct plan/corporate leadership regarding any necessary operational or regulatory changes

Lead conflict resolution for any provider relations or network issues that may occur

Reporting Relationship :

This position will be report directly to the South Carolina Medicaid President.

Required Qualifications

Bachelor's degree in Business, Operations Management, Healthcare Administration or related field

Minimum two (2) years of experience in health plan management

Four (4) to six (6) years of experience working in healthcare operations

Leadership background with more than five (5) direct-reports

Residence in South Carolina with frequent travel to Columbia area required

Preferred Qualifications

Master's degree

Experience responding to state and/or federal government solicitations

Medicare Dual Eligible Demonstration experience

Medicaid health plan experience in strategic and thought leadership

Medicaid Long term care experience

Additional Information

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com