Job #: 1263
Title: Director of Health Fund
Momentum is looking for a Director.
The Fund is seeking a candidate for the Director of Health Fund Operations. The successful candidate will be responsible for overseeing the day to day provider-related and member-related operations that support the Fund’s strategic programs to deliver cost effective and high quality health care coverage to its plan participants. This position reports to the Health Fund’s Director.
Essential Duties and Responsibilities:
· Manage relationships with health care providers who serve as 5 Star Centers and other Partners, in order to provide Health Fund participants with access to high-quality, cost-effective care.
· Manage protocols for responding to inquiries and complaints received from providers and Fund participants specific to 5 Star Centers and other Partners.
· Act as a liaison between the Fund and its Third Party Medical/Hospital Administrator to resolve inquiries and complaints from providers and members about claims and network participation.
· Maintain and monitor processes to enroll members into unique benefit programs, such as the 5 Star Wellness Program which encourages Health Fund participants with chronic conditions to seek high quality primary care and maintain compliance with their prescription medication.
· Supervise the Health Services Unit within the Health Fund. The staff in the this unit provide concierge level service in assisting members with:
o Making appointments at 5 Star Centers
o Resolving billing and provider issues at 5 Star Centers
o Enrolling participants into the 5 Star Wellness program
o Identifying in-network providers for all types of medical care
o Answering questions about specific and complex aspects of the benefits
o Informal Dispute Resolution on billing issues and benefit coverage
· Supervise the Clinical Manager who negotiates out-of-network bills for emergency services
· Supervise the Health Fund’s Marketing and Relationship Manager who manages the relationship with 5 Star Center and takes the lead on Health Fund marketing materials.
· Supervise the Health Funds’ Social Work team which assists members in:
o Accessing services through specific Partners
o Transitioning from active coverage to Short Term Disability, Long Term Disability, Cobra, or other sources of coverage
o Identifying and accessing resources not usually covered through the Health Fund.
· Collaborate with the Health Fund leadership to design and implement benefit changes that focus on quality and bend the health care cost curve without shifting costs to members.
· Supervise a continuous quality improvement program that determines operational targets, measures performance, and improves program outcomes. As needed, advise Fund management about systematic problems that pertain to members and the providers from which they seek care.
· Coordinate resources with other Fund departments to efficiently deliver benefits.
· Assist with the development and implementation of special projects which are meant to improve health outcomes and reduce the cost of providing health benefits.
The ideal candidate is someone with both project management/operations experience in a health care setting as well as experience working with physician networks. Qualifications include:
· Minimum of seven (7) years of relevant experience in a health care or health plan setting, with progressive levels of responsibility and a track record of consistent quality and efficiency improvements.
· Demonstrable knowledge and understanding of the health care delivery system and health .
· Strong leadership skills, combined with an ability to work well independently and well as part of a team.
· Ability to effectively lead a staff of 10+ with diverse skill sets and roles, with a minimum of three (3) years of supervisory experience.
· Excellent communication skills, both oral and written, demonstrated by an ability to coordinate and communicate with internal and external contacts.
· High degree of analytical skills demonstrated through extensive experience analyzing data, identifying problems, and recommending solutions.
· Evidence of sound problem-solving and decision-making skills for resolving participant, and provider issues, processing, and workflow issues.
· Well organized, attentive to detail and able to multitask and manage projects.
· Ability to plan and successfully implement program initiatives in a timely manner.
· Ability to prioritize work and meet deadlines.
· Able to proficiently use MS Office software packages.
· College degree- BS or BA. An MBA, MPH, or MPA a plus.