POSITION SUMMARY:
The Executive Director of Operations is responsible for leading health plan operations across all four of JHHP’s lines of business, ensuring operational excellence while striving to improve member and provider satisfaction.
Responsibilities include leadership and accountability for performance results of all Operations division functions including claims, customer service (member and provider), enrollment, systems configuration, education and training, quality assurance, business operations analytics, facilities, and provider accounts and receivables. This role has oversight of the health plan business process as a service (BPaaS) performance and relationship for three of its four lines of business in addition to oversight for the Operations budget.
Promotes quality and productivity improvements through improved procedures and process improvements, supporting the strategic direction of the organization. Facilitates improvement initiatives through cross business unit collaboration.
Creates insightful reports and effectively conveys information to executive-level stakeholders. Contributes to and executes on the strategic and operational plans in support of all lines of business. Collaborates with the line of business leaders, Medical Management, Finance, Provider Network, and Information Technology to ensure the effective and efficient administration of services.
The Executive Director establishes a strategic vision and communicates current and long-range division goals and objectives. Monitors results on a regular basis, adjusting plans and performance expectations to achieve targeted results. Ensures all critical service metrics and operational results are achieved. Ensures compliance requirements are met for all regulatory bodies including CMS, NCQA, HEDIS, and Delmarva, as well as internal and external auditors.
REPORTING RELATIONSHIP
Reports directly to COO- JHHP and is responsible for all aspects of management for Directors, Managers, Supervisors, and individual contributors in the Operations department. Assigns work and provide guidance and direction to others.
EDUCATION & EXPERIENCE:

1. Bachelor’s degree in health-related, quality, or business field such as business or health care administration. Master’s degree strongly preferred
2. 10 years of progressive Operations leadership experience in managed care/health plan environment.
3. Experience championing large-scale transformational projects.
4. Experience managing health-care reimbursement methods to develop and implement strategies for claims processing and adjustment operations.
5. Experience managing budget and allocating resources with record in the execution of managing operational budgets.
6. Experience designing, building, and reorganizing operational processing teams with ongoing development of skill and leadership competency.

KNOWLEDGE
Demonstrated knowledge of Medicare, Medicaid and Commercial health care plans, regulatory requirements, systems functions with in-depth operational and customer service experience. Operations management, change management, process improvement, and health care-related customer service methods. Knowledge of and continual development in current industry trends, best practices and market impact. Operational knowledge and expertise in leading, operating, and monitoring performance of high volume claims and enrollment services.