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Senior vice president Empleos en Virginia beach va
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Senior Vice President, Health Plan Operations
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FISDDHS, Virginia, United States of AmericaSenior Vice President, Health Plan Operations
SentaraVirginia Beach, VA, United StatesCity / State
Virginia Beach, VA
Overview
Work Shift
First (Days) (United States of America)
Sentara Health Plans provides health plan coverage to close to one million members in Virginia and Florida. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees. We are seeking a dynamic and experienced Senior Vice President of Health Plan Operations to lead and oversee all operational aspects of our health plans. This critical leadership role will ensure efficient and effective delivery of services to our members, while driving continuous improvement and innovation.
Sentara Health Plans is part of a larger integrated delivery network, Sentara Health. Sentara Health is largest provider in the Commonwealth of Virginia and the combined entities generate approximately $14 Billion in annual revenues.
Position Summary :
Reporting directly to the President / CEO of the Health Plan, the Senior Vice President of Health Plan Operations is responsible for the strategic direction, operational execution, and financial performance of health plan operations, encompassing claims processing, enrollment, member services, member, provider call center and broker services, quality improvement, and regulatory compliance. This role requires a deep understanding of the managed care landscape, strong leadership skills, and a proven ability to drive operational excellence. This role is also responsible for the development, scaling, and execution of Claims and Health Plan operations focused on simplifying end-to-end customer experiences and business processes, while reducing operational expenses and risks leveraging a modern technology stack.
Key Responsibilities :
- Strategic Leadership : Develop and implement the strategic vision and operational plans for health plan operations, aligned with the organization's overall goals and objectives. Anticipate market trends and regulatory changes and proactively adapt operational strategies to maintain a competitive edge.
- Operational Excellence : Oversee the day-to-day operations of key departments, including claims processing, enrollment, member / provider call center / broker services, and regulatory compliance. Establish key performance indicators (KPIs) and drive continuous improvement initiatives to optimize efficiency, accuracy, and customer and associate satisfaction.
- Financial Performance : Manage the operational budget and ensure cost-effective resource allocation. Identify and deliver opportunities for cost savings and revenue enhancement, while maintaining high-quality service delivery.
- Risk Management and Regulatory Compliance : Implement governance structures to manage data exchanges and compliance with state and federal regulatory standards. Lead
initiatives to mitigate operational risks and ensure compliance with healthcare regulations and standards. Maintain up-to-date knowledge of regulatory requirements and implement necessary policies and procedures.
Qualifications : Education :
Experience :
LI-AR
Job Summary
Sentara Health Plans provides health plan coverage to close to one million members in Virginia and Florida. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees. We are seeking a dynamic and experienced Senior Vice President of Health Plan Operations to lead and oversee all operational aspects of our health plans. This critical leadership role will ensure efficient and effective delivery of services to our members, while driving continuous improvement and innovation.
Sentara Health Plans is part of a larger integrated delivery network, Sentara Health. Sentara Health is largest provider in the Commonwealth of Virginia and the combined entities generate approximately $14 Billion in annual revenues.
Position Summary :
Reporting directly to the President / CEO of the Health Plan, the Senior Vice President of Health Plan Operations is responsible for the strategic direction, operational execution, and financial performance of health plan operations, encompassing claims processing, enrollment, member services, member, provider call center and broker services, quality improvement, and regulatory compliance. This role requires a deep understanding of the managed care landscape, strong leadership skills, and a proven ability to drive operational excellence. This role is also responsible for the development, scaling, and execution of Claims and Health Plan operations focused on simplifying end-to-end customer experiences and business processes, while reducing operational expenses and risks leveraging a modern technology stack.
Key Responsibilities :
initiatives to mitigate operational risks and ensure compliance with healthcare regulations and standards. Maintain up-to-date knowledge of regulatory requirements and implement necessary policies and procedures.
Qualifications : Education :
Experience :
Qualifications : Education :
Budgeting, Healthcare Management, Health Insurance Plans, Management
Skills
Active Learning, Active Learning, Active Listening, Communication, Complex Problem Solving, Coordination, Critical Thinking, Judgment and Decision Making, Leadership, Learning Strategies, Marketing, Mathematics, Mgmt of Financial Resources, Mgmt of Material Resources, Mgmt of Staff Resources, Microsoft Excel, Microsoft Word, Monitoring, Negotiation, Persuasion, Project Management, Quality Control Analysis, Reading Comprehension, Science, Service Orientation {+ 7 more}
Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.
In support of our mission "to improve health every day," this is a tobacco-free environment.