Regional VP Operations Medicaid

Profile

Job Information

Humana

Regional VP, Operations Medicaid

in

Tulsa

Oklahoma

Description

The Chief Operating Officer (COO) establishes long-range goals, objectives, and plans and monitors financial and operational performance. They will be responsible for the strategic development and oversight of operations for Humana's Oklahoma 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. The COO represents the Plan externally and to State and external agencies.

Responsibilities

Directs and coordinates day-to-day plan functions, including Reporting, Claims Administration, Encounter Data Quality, Grievance and Appeals, Information Technology and Systems, Enrollee Services, Provider Services, and Business Continuity Planning and Emergency Coordination

Liaise among OHCA, plan leadership, and corporate contacts responsible for the execution of Contract deliverables

Works with the plan Chief Executive Officer to maintain important stakeholder relationships throughout Oklahoma

Leads internal infrastructure to review and improve operational functions

Manages implementation of strategic plans developed in cooperation with the Plan leaders

Oversees development and maintenance of operational policies and procedures

Effectively implements business plans and oversees audit processes

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

Plans organizational growth and potential staff successions

Develops and cultivates a diverse and inclusive environment

Maintains intimate familiarity with Contractual requirements and stipulations

Understands and actively manages ongoing adherence to local, State, and federal regulatory and programmatic requirements

Mitigates risks potentially impacting the State of Oklahoma and the plan by proactively monitoring any risk factors and red flags that may arise during operations

Communicates with OHCA and direct plan/corporate leadership regarding any necessary operational or regulatory changes

Leads conflict resolution for any Provider relations or network issues that may occur

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 ​

Preferred Qualifications

Master's degree

Experience in strategic and thought leadership in supporting Medicaid health plans

Additional Information

This role is based in Oklahoma City

Role is leveled as RVP, Operations

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

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