UNITE HERE HEALTH

  • Senior Manager of Healthcare Delivery

    Job Locations US-IL-Aurora
    Posted Date 4 weeks ago(9/20/2018 11:28 AM)
    ID
    2018-1482
    # of Openings
    1
    Category
    Healthcare Delivery
    Company
    UNITE HERE HEALTH
  • Overview

    betterworkplaceuhh

     

     

    Looking for a way to influence the health and healthcare of many?

     

    If so, we’d love to hear from you! Our mission-driven organization is focused on theTriple Aim - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans.

     

    UNITE HERE HEALTH serves 100,000+ workers, 220,000 covered lives in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

     

     

    Key Attributes:

     

    • Integrity – Must be trustworthy and principled when faced with complex situations
    • Ability to build positive work relationships – Mutual trust and respect will be essential to the collaborative relationships required
    • Communication – Ability to generate concise, compelling, objective and data-driven reports
    • Teamwork – Working well with others is required in the Fund’s collaborative environment
    • Diversity – Must be capable of working in a culturally diverse environment
    • Continuous Learning – Must be open to learning and skill development.  As the Fund’s needs evolve, must be proactive about developing new areas of expertise
    • Lives our values – Must be a role model for the Fund’s BETTER Culture and Mission (Better, Engage, Teamwork, Trust, Empower, Respect)

    The Director of Managed Care Contracting is responsible for the managed care contracting for the Aurora based Plan Units. There are three parts to this role: First, the Director works with the Senior Director, HCD and the Regional Directors on Healthcare Delivery to develop and manage the strategic planning efforts for Healthcare Delivery as it relates to managed care contracting. Secondly, the Director is responsible for overseeing the management of the Aurora Healthcare Delivery Team who manage the day-to-day contractual relationships with the managed care vendors and providers. Thirdly, the Director is fully responsible for the Service Provider Resolution process of the Fund.

     

    Responsibilities

    The Sr. Manager of Healthcare Delivery is responsible for providing management services to the Healthcare Delivery Support Team by managing and monitoring managed care vendor and provider relationships and services in conjunction with working with the Regional Directors, managing the Managed Care Specialists and participating in plan design and analysis projects.

    • Collaborates with senior leadership to develop and implement plans for the operational infrastructure of systems, processes, and personnel that support strategic goals and initiatives
    • Creates, motivates and leads a high performing team; provides mentoring as a foundation of career development and builds a culture designed to engage, enable and empower staff
    • Directs functions, staff and systems necessary to ensure that health plan participants and their families receive benefit coverage timely and without unnecessary delay
    • Establishes and maintains appropriate procedures and controls to ensure accuracy, efficiency, productivity and regulatory compliance is maintained for areas of accountability
    • Maintains and cultivates strong relationships with multiple internal and external stakeholders across geographic regions
    • Creates and directs an efficient and effective operating system to enable all Fund customers to receive the highest level of service by getting accurate, consistent and timely answers specific to their inquiries, using problem-solving and results-based parameters
    • Plans and prepares operating budget
    • Performs other duties as assigned within the scope of responsibilities and requirements of the job
    • Performs Essential Job Functions and Duties with or without reasonable accommodation

     

    Qualifications

    Education and Certifications

    • Bachelor's degree in Business Administration, Public Health, Healthcare Administration or related field or equivalent work experience required
    • Preferred: Master’s degree in Business Administration, Public Health, Healthcare Administration or related field

    Knowledge and Experience

    • 7 ~ 10 years of related experience minimum
    • 3 ~ 5 years of team management experience required
    • Working knowledge and experience with current legislative requirements under ACA, COBRA, HIPAA, DOL, etc. as they relate to health benefits eligibility, payment, and appeals
    • Demonstrated leadership and interpersonal skills in order to lead others to achieve results in a team oriented environment through the use of feedback, accountability and change management
    • 3 ~ 5 years Provider and/or Vendor contracting experience including negotiating contract provision and financial reimbursement/payment rates.
    • Working knowledge of multiple health services reimbursement methodologies including, capitation, per diems, DRG’s and RBRVS fee schedules.
    • Experience in process improvement, creating efficiencies, documenting processes including development of policy and procedure manuals
    • 3 ~ 5 years Project Management experience including leading and participating in cross functional teams to deliver on expected outcomes.

    Essential Skills and Abilities  

    • Intermediate level Microsoft Office skills (PowerPoint, Word, Outlook)
    • Intermediate level Microsoft Excel skills
    • Preferred fluency (speak and write) in Spanish
    • 10% ~ 15% travel
    • Comfortable with the use of technology in the accomplishment of responsibilities such as videoconferencing, creating PowerPoint presentations, use of Excel to create statistical analysis and use of other Microsoft Office tools
    • Strong written and verbal skills.
    • Project management skills strongly desired
    • Manage competing deadlines and multiple projects in a fast-paced environment

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