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Director of Operations

2 months ago

Boise Idaho, United States St. Luke's Health System Full time
{"title": "Director of Operations", "content": "Job Summary

The Director of Operations at St. Luke's Health Plan is a senior leadership position responsible for overseeing the strategic and operational aspects of the Medicare Advantage line of business. This role is pivotal in ensuring the efficient and compliant administration of MA plans by working closely with the operations leadership team.

Key Responsibilities
  • Collaborate with operations leadership to ensure the effective execution of Medicare Advantage initiatives across enrollment, billing, claims processing, member services, and provider network operations.
  • Ensure operational processes and practices are compliant with CMS regulations, state laws, and internal policies.
  • Leverage data analytics for informed decision-making and optimized operational workflows.
  • Identify and recommend process improvement initiatives to operations leadership to enhance operational efficiency, reduce costs, and improve member satisfaction.
  • Partner with IT and other departments to explore technology solutions that enhance operational effectiveness.
  • Coordinate with product development, marketing, finance, and other departments to facilitate the growth and success of the MA program.
  • Partner with the Compliance and Privacy Officer to lead the annual Medicare Compliance risk assessment, identifying, analyzing, and mitigating potential noncompliance risks.
  • Provide input on operations budget for the Medicare Advantage line of business in collaboration with finance and operations leadership.
  • Monitor financial performance, identify variances, and recommend corrective actions to meet budgetary goals.
  • Develop and cost-saving initiatives and optimize resource allocation.
  • Prepare and present detailed reports on Medicare operational activities to the Executive Committees, Plan Leadership, and the Board of Directors, ensuring transparency and accountability at all levels.
Requirements
  • Bachelor's Degree or experience in lieu of degree.
  • 8 years' relevant experience (ie, health plan operations, Medicare Advantage).
About St. Luke's

At St. Luke's, caring for people in the communities we serve is our mission – and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Virgin Pulse Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.

St. Luke's is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

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