Partnership In Care Operations Director

4 days ago


Brooklyn, New York, United States MetroPlus Health Plan Full time

MetroPlus Health Plan is a leading healthcare organization dedicated to providing high-quality services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island.

Job Summary:

We are seeking an experienced Partnership In Care Operations Director to lead our Partnership in Care department. As a key member of our leadership team, you will be responsible for overseeing the day-to-day operations of our department, ensuring adherence to regulatory requirements, audits, quality, and compliance activities.

You will work closely with analytics, IT, provider network operations, quality management, claims, and compliance teams to ensure all projects and processes are completed as required. Your expertise in project management, data analysis, and stakeholder engagement will be invaluable in driving our mission forward.

Responsibilities:

  • Oversight of Partnership in Care operations, including eligibility, retention, and compliance activities
  • Ensuring compliance with Federal, State, and city regulations as they relate to Partnership in Care
  • Management of key performance improvement projects impacting the department's outcomes and compliance
  • Preparation for compliance audits, such as Article 44 and IPRO reviews
  • Data collection of HIV viral load lab test results across major laboratory vendors, hospitals, community providers, and other agencies

Requirements:

  • Bachelor's degree in a healthcare-related field required
  • Five plus years of relevant managed care and operations management experience required
  • Strong analytical and strategic planning skills
  • Experience managing projects for external customers and developing effective customer relationships

Our company offers a competitive salary of $105,000 - $112,000 per year, based on experience, plus excellent benefits and opportunities for professional growth and development.



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