Leads and manages all hands-on operational aspects and activities of various functional areas within the Plan which may include: Claims, Provider Services, Information Technology, Grievance and Appeals and Member Services. Assists the Plan leader in the successful growth and performance of the Plan. Interfaces, collaborates and works cooperatively with corporate office functional leaders and centralized business departments
Reports to:Medicare Region President
Location:New Hampshire, Maine, Vermont, Massachusetts, Connecticut, Rhode Island
Provides day-to-day leadership and management to a service organization that mirrors the mission and core values of the company. Interfaces with corporate operations office staff as required.
Drives the Plan to achieve and surpass operational performance metrics, profitability, and business goals and objectives.
Oversees employee compliance with, and measurement and effectiveness of, all Business Standards of Practice including Project Management and other processes internal and external. Provides timely, accurate, and complete reports on the operating condition of the Plan. Develops policies and procedures for assigned areas. Ensures that other impacted areas, as appropriate, review new and changed policies.
Assists State President in collaborative efforts related to the development, communication and implementation of effective growth strategies and processes. May be required to spearhead the implementation of new programs, services, and preparation of bid and grant proposals.
Collaborates with management team and others to develop and implement action plans for the operational infrastructure of systems, processes, and personnel designed to accommodate the rapid growth objectives of the organization.
Assists in defining marketing and advertising strategies within State guidelines. Participates in the development and implementation of marketing policies for the Plan, and ensures their compliance with program regulations.
Provides assistance in preparation and review of budgets and variance reports for assigned areas.
Communicates, motivates and leads a high performance management team. Attract, recruit, train, develop, coach, and retain staff. Fosters a success-oriented, accountable environment within the Plan.
Ensures compliance to and consistent application of law, rules and regulations, company policies and procedures for all assigned areas.
Ensures prompt response with a sense of urgency/priority to customer requests. Documented follow through/closure.
Performs other duties as assigned.
Required Bachelor's Degree in a related field
Preferred Master's Degree in a related field
Required 10 years of experience in an operations environment specifically with claims, customer service, provider services administration, project management and/or information technology
Required 5 years of management experience
Required Other Experience with the design, development and administration of managed health care programs (Medicaid and other Government programs) preferred. Demonstrate successful experience in cross functional team implementation, projects, etc
Required Other Excellent human relations, leadership and interpersonal relationship skills, engagement of employees, staff coaching skills required
Advanced Ability to analyze information and covert related activities into a comprehensive work plan
Advanced Ability to communicate and make recommendations to upper management
Advanced Ability to effectively present information and respond to questions from families, members, and providers
Advanced Ability to effectively present information and respond to questions from peers and management
Advanced Ability to drive multiple projects
Advanced Ability to implement process improvements
Advanced Ability to influence internal and external constituents
Advanced Demonstrated leadership skills
Advanced Demonstrated project management skills
Advanced Demonstrated time management and priority setting skills
Advanced Knowledge of healthcare delivery
Advanced Ability to lead/manage others
Advanced Demonstrated analytical skills
Advanced Demonstrated interpersonal/verbal communication skills
Required Advanced Microsoft Excel
Required Intermediate Microsoft Outlook
Required Intermediate Microsoft Word
Required Intermediate Microsoft PowerPoint
Required Intermediate Microsoft Project
Required Intermediate Operations Management Systems (Generic)
About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.