Director of Clinical Operations & Revenue Compliance

Location
Norfolk, VA
Salary
Competitive
Posted
Mar 05, 2019
Closes
Mar 20, 2019
Ref
121393BR
Function
Other
Industry
Other
Hours
Full Time
Overview:

Optima Health is hiring an experienced leader to serve in the role of Director of Clinical Operations & Revenue Compliance in Norfolk, VA.

Department/Position Overview:

As the Director of Clinical Operations & Revenue Compliance, this licensed professional will lead up to 4 regions of the Virginia Medicaid sector of the Optima health plan. This includes at least 5 direct reports (managers) and multiple indirect reports (RNs, Care Coordinators, and clinical support staff). These Medicaid teams will consist of both office-based employees and remote/field based employees collectively. A Master's Level Degree with an associated license is required, as well as 5 years of managed care experience and healthcare. Extensively leadership is desired with an emphasis in employee development, building a strong integrated team with different roles, and an innovative approach to management that is goals orientated and positively aligns with the complexities of our business.

Division Highlights:

Optima Health offers a full suite of commercial health insurance products including employee-owned and employer-sponsored plans, as well as Individual and Family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services.

As a nationally recognized provider of health plan coverage and innovative wellness programs, we live our mission "to improve health everyday." This same commitment and dedication directs our philosophy as an employer. When you join Optima Health, you will experience our deep passion for heal and service excellence while benefiting from a culture of opportunity, learning, career growth, and support --every day. Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.


Sentara Benefits:

Sentara employees strive to make our communities healthier places to live. We’re setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, CLICK HERE!

Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!

Other
Licensed professionals, licensure in accordance with professional discipline required.

Keyword: MLTSS, Medicaid, leadership, director, manage care, health plan, clinical care.

Equal Opportunity Employer
Sentara Healthcare maintains a drug-free workplace.

Responsibilities:

This position coordinates financial goals, resources and opportunities for improvement in Product lines. The position is accountable for implementing all contractual agreements, compliance with Federal, State and Accreditation Standards for Medical Care Management. Responsibilities include both strategic planning and support in areas assigned. Supports the Vice President's for Clinical Care Services in meeting the goals of the departments. The Director of Operations works independently and with all functional areas of Commercial or Government Clinical Care Services; may direct: Case Management, Disease Management, Utilization Review, Appeals/ Complaints, After Hours and Clinical Revenue Coding, which typically support multiple lines of business. Will lead a cross-functional departmental Risk Adjustment Team and assume responsibility for overall management methodologies developed by HHS according to the Affordable Care Act regulations. Will develop, analyze, and remediate the performance of initiatives.

Qualifications:

Education Level
Master's Level Degree

Experience
Required: Healthcare - 5 years, Managed Care - 5 years

Preferred: None, unless noted in the "Other" section below

License
None, unless noted in the "Other" section below

Skills
Required:

Preferred: None, unless noted in the "Other" section below

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