Job added in hotlist
Applied job
Contract job
90-day-old-job
part-time-job
Recruiter job
Employer job
Expanded search
Apply online not available
View more jobs in Spartanburg, SC
View more jobs in South Carolina

Job Details

SC Medicaid Market Director

Company name
Humana Inc.

Location
Spartanburg, SC, United States

Employment Type
Full-Time

Industry
Operations, Manager

Posted on
Feb 11, 2021

Apply for this job






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

I was very pleased with the ManagerCrossing. I found a great position within a short amount of time … I definitely recommend this to anyone looking for a better opportunity.
Jose M - Santa Cruz, CA
  • All we do is research jobs.
  • Our team of researchers, programmers, and analysts find you jobs from over 1,000 career pages and other sources
  • Our members get more interviews and jobs than people who use "public job boards"
Shoot for the moon. Even if you miss it, you will land among the stars.
ManagerCrossing - #1 Job Aggregation and Private Job-Opening Research Service — The Most Quality Jobs Anywhere
ManagerCrossing is the first job consolidation service in the employment industry to seek to include every job that exists in the world.
Copyright © 2024 ManagerCrossing - All rights reserved. 169 192