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Senior Operations Manager
2 months ago
The Provider Operations & Credentialing team is responsible for ensuring adherence to both regulatory and business standards for our network of contracted providers. The Senior Operations Manager will report directly to the Senior Director of Provider Operations & Credentialing.
In this capacity, you will act as the primary custodian for maintaining compliance within our contracted provider network, ensuring alignment with all regulatory mandates across various Lines of Business.
Our leadership philosophy emphasizes the development of exceptional leaders at every level and creating avenues for our personnel to advance – personally, professionally, and financially.
We seek leaders who are invigorated by innovative and analytical thinking, nurturing and sustaining high-performing teams, achieving results ethically, and promoting continuous learning.
Your ResponsibilitiesIn this position, you will:
Oversee multiple teams, departments, or functional areas; drive outcomes in accordance with strategic planning, cost management, and methodologies.
Foster a positive workplace culture by clearly articulating the mission, vision, goals, roles, and expectations for team members; acknowledging top talent and team accomplishments; cultivating successful working relationships across the organization; ensuring a safe and healthy work environment; providing the necessary tools, time, and talent for success.
Manage budgetary considerations, resource allocation, process enhancements, and technological advancements for the teams, departments, or functional areas under your purview.
Develop and execute the annual budget.
Oversee several interrelated projects, often aimed at enhancing the organization’s performance.
Validate and manage the contracted provider network to ensure compliance with all regulatory requirements across diverse Lines of Business. This includes Operational Controls and Credentialing Controls to serve as a gatekeeper for provider approval for deployment.
Supervise Credentialing Operations to guarantee both regulatory and business compliance with requirements.
This encompasses Inventory Management, System Access and Security, Provider and Facility Credentialing to full compliance, Vendor oversight, Auditing and Quality Assurance, and System/Database management.
Act as an active leader within Operations to support business outcomes across functions, enhancing and sustaining operational performance and compliance with regulatory and business commitments.Your Qualifications
Requires a bachelor’s degree or equivalent experience.
Requires a minimum of 10 years of relevant experience, including 4 years in a management role.
Preferred experience and understanding of Inventory Management concepts and controls.
Preferred knowledge and experience in Credentialing requirements for Commercial and Medi-Cal Lines of Business.
Preferred expertise in Quality Assurance and Auditing.
Preferred experience in developing and executing Operational Controls and managing a Control Environment.
Preferred skills in assessment, diagnostics, and remediation.
Preferred Customer & Relationship Management skills.
Compensation Range:
The compensation range for this role is: $132,000.00 to $181,000.00 for California.
Note:
This range represents the compensation for this and many other positions at Blue Shield that fall into this pay grade.
Blue Shield salaries are determined by various factors, including the candidate's experience, location, and current employee salaries for similar roles.
