The Associate Director, Shared Services owns the overall relationship with CDOs or outside entities of which are purchasing operational services from WellMed. This position develops and executes strategies that impact these entities with multiple functional departments and all health plans. The position works closely with the all operational departments to ensure compliance with contractual obligations. This position should be the primary point of contact for escalated disputes or issues from the entities and included but not limited to legal and regulatory and executive levels within the organization. This position also has daily oversight accountability of the relationship with these entities and to ensure WellMed’s compliant performance on all metrics as defined in delegation agreements and / or third party agreements. The position will be responsible for validating, delivering and refining the required reporting as outlined in agreements. The position works collaboratively with other internal Network Operations leadership to root cause and solve systemic issues.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Work collaboratively with all Network Operations leadership to ensure daily operations are in compliance with agreements in place
- Oversee and monitor overall claims performance as it relates to the outside entities and adhere to metrics
- Provide guidance, expertise and / or assistance to internal and external partners to ensure programs or strategies are implemented and maintained effectively
- Apply knowledge of current, new or future products and services to the teams appropriately
- Ensure performance is tracked and reported accurately utilizing dashboards, scorecards and reports
- Manipulate provided data into applicable tools and reports in order to determine overall effectiveness
- Develop relationship with appropriate counterparts with outside entities and ensure regular meetings and communication are occurring
- Strategize with entities around operational improvement opportunities
- Develop and adhere to timelines around reporting and communication expectations
- Ensure that all output written documents meet all regulatory requirements
- Participates in strategy and development of new tools and resources as needed
- Participate and present appropriate documentation and walk throughs to support the entity and/or the WellMed operational departments
- Collaborate with department leads on improving process flows and identifying opportunities for improvement
- Maintains current knowledge of CMS regulation and compliance requirements related to claims
- Bachelor’s Degree of Business Administration or a related field or 8+ years of comparable work experience
- 5+ years of progressive healthcare experience, specifically in managed care
- 4+ years of supervisory / management experience or managing cross functional relationships
- Knowledge of health plan regulatory standards
- Proficiency with Microsoft Office applications
- Bachelor's degree or higher
- Health plan quality, audit, claims or compliance experience in a managed care environment
- Strong knowledge of Medicare / CMS guidelines
- Previous experience with delegation audits
- Strong leadership experience
- Ability to work in the San Antonio, TX office location
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Associate Director, Shares Services, San Antonio, Texas, TX, Telecommute, Telecommuting, Working from Home,