Network Management Business Operation Specialist or Senior, DOE

7 days ago

Portland, United States Cambia Health Solutions, Inc Full time


Network Management Business Operation Specialist or Senior, DOE

Remote opportunity for residents of OR, WA, ID and UT







Primary Job Purpose

The Network Management Business Operations Specialist and Senior apply analytical skills, project management, and subject matter expertise to research and resolve issues, support various business initiatives, perform ad hoc reporting, and improve effectiveness of Network Management business operations. These roles lead large, complex projects in support of Network Management initiatives to ensure successful delivery of the project to department standards. The Network Management Business Operations Specialist or Senior manages project work with greater scope and complexity and require application of deeper subject matter and systems expertise. These roles collaborate with cross-functional stakeholders and leadership across the company in all Cambia markets to support Network Management for all Plans.



General Functions and Outcomes

  • Leads, under the direction of management, projects and initiatives for non-routine support of operations.

  • Provides subject matter expertise, direction, and solutions related to assigned projects or business processes. Assists in the design and implementation of related administrative policies and procedures, and provides related guidance and direction to the team.

  • Applies analysis of business systems and data processing solutions to increase efficiency and effectiveness of work processes.

  • Supports process improvement initiatives and coordinates with appropriate staff, including leadership, to ensure all new processes and procedures are approved, clearly documented and implemented.

  • Participates in definition of project deliverables, providing consultation, recommendations and solutions, reviewing project mandates and directives to determine overall Network Management approach and impact on administrative and IT systems.

  • Communicates and reports status and collaborates with leadership to continually assess viability of work plan and deliverables and resolve issues. Engages and coordinates with project staff and other resources from various functional areas.

  • Contributes to preparations for compliance audits, accreditation documentation and government audits.

  • Facilitates and drives multiple projects; accountable for integrating with dependent projects and processes, oversees program and project scope, risks and issues management, and schedule.

  • Assists leadership with problem identification and resolution, and program development by researching, assessing, and analyzing issues, and providing recommendations.

  • Identifies and drives execution of organizational, procedural, and operational changes and functions within and across plans.

Additional General Functions and Outcomes for Network Management Business Operation Specialist

  • Leads, under the direction of management, strategic initiatives, compliance implementations, and sustainment projects for Network Management business

  • Provides team leadership in developing project plans, creativity in the planning and implementation of assigned projects, monitoring progress to execute on time according to key project milestones, ensures risk mitigation and communication with stakeholders and leadership occurs timely until successful completion of project.

  • Provides broad perspective to identify and implement solutions related to projects or business processes

  • Drives the design and implementation of related administrative policies and procedures, and provides related guidance and direction to the team.

  • Facilitates and drives multiple projects; accountable for integrating with dependent projects and processes, oversees program and project scope, risks and issues management, and schedule.

  • Assists leadership with problem identification and resolution, and program development by researching, assessing, and analyzing issues, and providing recommendations.

  • Identifies and drives execution of organizational, procedural, and operational changes and functions within and across plans.

Minimum Requirements

  • Proven expertise in one or more of the following areas of health plan administration: Claims processing, provider relations, information technology, customer service, contract management or analytics.

  • Demonstrated effectiveness in verbal and written communication skills with different organizations levels.

  • Proven ability to identify project and initiative problems and risks, develop mitigation plans and solutions and implement a chosen course of action.

  • Demonstrated ability to collate, analyze, organize and interpret statistical and other data for the purpose of project and initiative research and development.

  • Ability to work under pressure and lead multiple assignments simultaneously.

  • Demonstrated knowledge of MS Office products with the ability to learn corporate software as needed.

Additional Minimum Requirements for Network Management Business Operation Specialist Senior:

  • Demonstrated leadership skills with the ability to direct and coordinate activities of individuals, implementation teams, and external agencies.

  • Working knowledge of Cambia's business processes, products and systems and an understanding of how they interrelate across departments and divisions.

  • Familiarity with process improvement and project management tools, methodologies, and industry standards.

Normally to be proficient in the competencies listed above

Network Management Business Operations Specialist would have a Bachelor's Degree in healthcare, business or related field and 4 years of progressively broad experience in healthcare administration, project leadership or project support or equivalent combination of education and experience.

Network Management Business Operations Specialist Senior would have a Bachelor's Degree in healthcare, business or related field and 6 years of progressive experience in healthcare administration, project leadership or project support, including at least 2 years of experience in a Network Management/Provider Services role or equivalent combination of education and experience.

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