Senior Vice President of Operations

Minimum Qualifications:

Bachelor's degree in Business Administration, Healthcare Administration, or a related discipline is required.

A minimum of 10 years of progressively responsible senior management experience in healthcare operations or health plan administration is essential.

Comprehensive knowledge of operational processes within a Medicaid health plan is necessary.

In-depth understanding of health plan systems and technological frameworks is crucial.

Proficiency in health plan network management, particularly in value-based care and reimbursement methodologies, is required.

Leadership Skills:

Demonstrated ability to lead effectively, focusing on successful execution, professional growth, and employee engagement.

Key Responsibilities:

The Senior Vice President of Operations will ensure that MedStar Family Choice maintains the operational and technical infrastructure necessary to achieve both immediate and long-term strategic objectives.

As a vital member of the Senior Leadership Team, this role holds primary accountability for guiding the operational and technological strategy, programs, and investments of MedStar Family Choice, spearheading initiatives aimed at enhancing business processes and overall organizational performance.

This position will oversee all administrative operational aspects of the organization.

Responsibilities encompass planning, directing, organizing, controlling, and executing strategic plans and policies to ensure a robust operational framework and successful achievement of all goals.

The Senior Vice President will supervise vendor-supported shared services that facilitate service delivery to MedStar Family Choice's clientele and providers, including Administrative Operations, Delegated Vendor Oversight, Appeals and Grievances, Payment Integrity, and Centralized Care Management and Pharmacy Management platforms.

Accountable for overseeing all Medicaid operational functions, including enrollment, premium billing, plan benefits and configurations, provider reimbursement, claims management, appeals and grievances, and delegated vendor oversight.

Ensures that operational services and processes are executed efficiently, with high quality and full compliance, delivering optimal service to members and providers.

Ensures that effective operational business processes, applications, technological solutions, and equipment are in place to maximize organizational performance.

This includes ongoing evaluation and upgrades, as necessary, to support systems in collaboration with Information Systems colleagues.

Oversees the formulation and implementation of policies, workflows, and procedures for all operational activities.

Ensures that performance metrics are established to continuously monitor and enhance critical operational areas.

Guarantees that all operational activities comply with federal, state, and local laws and regulatory standards.

Provides executive oversight in collaboration with the Chief Medical Officer regarding contract relationships with MedStar Family Choice's Pharmacy Benefit Manager (PBM).

Directs the strategic vision for analytics and innovation, identifying opportunities to enhance the use of clinical information systems to improve healthcare and clinical service outcomes.

Develops and implements a strategy for provider data and performance management to assist providers in managing their risk effectively.

Oversees the establishment of enterprise-wide standards to ensure compatibility and integration of analytical systems with other IT platforms.

Incorporates outcomes-based analytical approaches into decision-making and business processes throughout MedStar Family Choice.

Participates in and drives the strategic transformation and innovation of enterprise systems to enhance outcomes and leverage MedStar Family Choice's capabilities effectively.

Collaborates with the Senior Leadership Team on all aspects of performance and process improvement related to clinical services and platforms utilized by MedStar Family Choice members.

Contributes to the medical cost control agenda and collaborates with the Executive Director & Chief Medical Officer to manage MedStar Family Choice's relationships with providers in Maryland and the District of Columbia.

Works closely with the Chief Medical Officer to oversee policies related to medical management that optimize costs and benefits for the organization while ensuring compliance with all legal and regulatory requirements.

Collaborates with Executive Directors for strategic oversight of all functions related to the development, management, and maintenance of MedStar Family Choice's provider network, including provider data and reimbursement policies.

Partners with Executive Directors to lead the strategic development and expansion of the provider network in Maryland and the District of Columbia for Medicaid products.

Collaborates with the Executive Leadership team to oversee the development and implementation of strategies that support network cost and quality performance aligned with the corporate mission through clinical programs and policies.

Oversees all strategic plans, policies, programs, and schedules related to computing and information technology for business data processing, network communications, and management information systems to achieve corporate objectives.

Works in partnership with the VP of Information Technology to manage all information technology functions within the organization.

Responsible for ensuring the security of data, information systems, communication lines, and equipment.

Acts to ensure the integrity of corporate data and proprietary information through information security and access management protocols that meet regulatory compliance standards.

Oversees the development, implementation, and ongoing assessment of all backup and disaster recovery programs and cybersecurity policies and procedures.

Establishes strategic partnerships with service providers and manages outsourced services, optimizing the balance of in-house versus outsourced services to enhance service cost-effectiveness.

Selects, manages, and oversees information technology service providers.

Oversees information technology planning and policy-making committees, including the Corporate Project Management Office and Corporate Agenda projects.

Oversees business systems and related process support, providing specialized expertise to ensure that business units optimize the capabilities of business systems and associated processes.

Ensures the performance of strategic outsourcing partners providing technology and back-office services meets or exceeds contractual obligations within established financial parameters.

Company Overview:

MedStar Health is a not-for-profit health system committed to serving the communities of Maryland and the Washington, D.C. region while advancing medical practice through education, innovation, and research. With a workforce of 30,000 associates, 6,000 affiliated physicians, and a network that includes 10 hospitals, ambulatory care, and urgent care centers, MedStar Health is recognized for excellence in medical care both regionally and nationally.

Specialties:

Cardiology, Cardiac Surgery, Oncology Services, Rehabilitation, Neurosciences, Orthopaedic Surgery, Women's Services, Emergency and Trauma Services.