Executive Director of Health Care Solutions

4 days ago

Lancaster, Pennsylvania, United States Penn Medicine Lancaster General Health Full time
Job Title: Executive Director of Health Care Solutions

Preferred Health Care (PHC) is a managed care company that has developed and operated health plan solutions across central and eastern Pennsylvania since its inception. Our core offering is Eliance Health Solutions, a self-funded health plan built by and powered by Penn Medicine. Our approach provides full claims administration, medical management, network development/contracting, wellness, and insurance agency services.

Key Responsibilities:
  • Provide strategic direction and operational oversight, including P&L management, financial control systems, budgeting, forecasting, and reporting.
  • Develop and execute growth strategies to expand the group health TPA market share, revenue, and profitability, while maintaining high client satisfaction and retention.
  • Lead, coach, and develop a high-performing team of managers and staff, ensuring alignment with the company's vision, mission, values, and goals.
  • Establish and maintain strong relationships with key stakeholders, clients, prospects, partners, vendors, and industry associations, representing PHC as a thought leader and trusted advisor.
  • Knowledge of the principles and practices of health planning and management sufficient to manage, direct, and coordinate the operation of a managed care organization.
  • Knowledge of the purposes, organization, and policies of health systems sufficient to interact with other health care systems and providers.
  • Knowledge of the policies and procedures sufficient to direct full health plan and claims operations effectively.
  • Knowledge of the principles and practices of employee development sufficient enough to ensure organizational productivity, employee retention, and employee development.
  • Knowledge of stop loss insurance and insurance agency development, growth, and operations sufficient to develop, nurture, and grow in support of PHC's business plans.
  • Establishing and maintaining effective working relationships with employees, policy-making bodies, third-party payors, hospitals, and other health care organizations, patients, and the public.
  • Drive innovation and continuous improvement in all of the company's solutions, leveraging technology, data, analytics, and best practices to enhance service delivery, quality, and efficiency.
  • Attend and provide management guidance to the Board of Directors, leading all planning and strategy development.
  • Ensure compliance with all applicable laws, regulations, policies, and standards.
  • Provides developmental leadership in the creation and operation of PHC's Third Party Administration, insurance agency, and stop loss marketplace programs in the support of Eliance Health Solutions and Penn Medicine.
  • Identifies and finalizes development of business relationships with third parties that are consistent with the overall business plans and objectives of PHC for Board approval.
  • Supports PHC's Quality Management Committee as needed and oversees administrative follow-up for problems and issues identified and led by the Medical Director.
Requirements:
  • Bachelor's degree in business, health administration, or related field.
  • Minimum 10 years of senior leadership experience in group health TPA, health insurance, or managed care industry, with a proven track record of delivering results.
  • Strong business acumen, financial management, and analytical skills, with the ability to develop and execute sound business strategies and plans.
  • Exceptional communication, presentation, and interpersonal skills, with the ability to influence and collaborate with diverse stakeholders at all levels.
  • Demonstrated leadership, coaching, and team-building skills, with the ability to inspire and motivate others.
  • Highly innovative, creative, and adaptable, with the ability to embrace change and drive transformation.

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