Sr. Manager Provider Operations

The Sr. Manager of Strategic Operations is responsible for establishing operational objectives, work plans, and delegating assignments to subordinate managers and individual contributors responsible for managing the day-to-day functions of the Strategic Operations team. The Sr. Manager is also responsible for leading Strategic Initiatives and Business Transformation efforts in support of our pre-eminent Provider Delivery System.

• Leads annual review of Provider Manual and updates/revisions by collaborating across teams including Delivery System Engagement, Marketing, Legal, and Regulatory to ensure compliance with Healthfirst, state, and federal government requirements
• Leads project management support for projects as assigned by Sr Leadership including but not limited to non-standard Provider contract implementation.
• Cultivates and strengthens relationships across the organization.
• Ensures deadlines are met, and reports on team's qualitative and quantitative statistics to Executive Management and other key stakeholders.
• Makes recommendations on strategy and process improvement to drive successful outcomes for workflows, processes and projects assigned.
• Leads and when applicable, manages overall productivity of Strategic Operations Teams, including establishing goals and providing direction to subordinate managers.
• Participates as department representative on internal/external audits, including state compliance audits in collaboration with Regulatory.
• Conduct monthly presentations on the unit’s performance and results.
• Responds to questions from Managers/Supervisors staff regarding assigned tasks, acts as liaison to other departments and is empowered to make policy decisions accordingly.
• Communicates decisions/rules to Managers/Supervisors in a clear and effective manner and ensures that the communication is passed along to the entire team.
• Attends meetings as team representative, provides updates, brings back, and shares relevant information.
• Hires, mentors, and coaches’ staff. Handles HR matters. Works with Quality Improvement and Training Specialists to ensure training materials and business requirements are accurate and appropriate.
• Participates as department representative on internal/external audits, including state compliance audits in collaboration with Regulatory.
• Works with internal business partners as needed to ensure successful roll out /completion of assigned initiatives/projects/deliverables (Regulatory, Product, Marketing, Compliance, Clinical Partnership, Population Health, Clinical Quality, etc.)
• Takes the lead and coordinating draft provider communications to ensure proper role out of initiatives to provider community; Works with Marketing to facilitate, create and roll out.
• Serves as a SME within DSE for initiatives assigned within DSE core areas (Hospital, Community, Ancillary, Behavioral Health, Vendor Management) that require additional support.
• Partners with the Director of Strategic Operations to implement reporting and inventory trends
• Additional duties as assigned.

Minimum Qualifications:

• Moderate experience and comprehension of multiple reimbursement methodologies including but not limited to DRG, Exempt Units, RBRVS, APCs, & APGs.
• Experience reading and interpreting data, identifying trends, recommending proactive solutions, and effectively communicating them to senior management.
• Moderate experience working with MS Office Suite to including creating PowerPoint Presentations and data reports in MS Excel, writing formulas, and displaying graphical trends as well as using MS Word to compose letters/memos and execute a mail merge.
• Experience evaluating risk, paying close attention to details and thinking critically in order to make sound business decisions.
• solving problems quickly and effectively.
• Experience in an Operations area, managing repetitive, back-office processes, in a high-volume, quality driven environment.
• Experience dynamically adjusting day to day operations and effectively leveraging resources to accommodate unexpected, time sensitive tasks.
• Previous experience managing change.
• Bachelor’s Degree from an accredited institution or equivalent experience.

Preferred Qualifications:

• 3 or more years of experience in a Leadership role within Managed Care Operations working with various business and cross functional teams to resolve Legal, Regulatory, Compliance, and Quality tasks including root cause analysis, corrective actions plans, and implementation of process improvements.
• 5 or more years of strategic planning and/or project planning including a progression from small, less complex tasks to larger initiatives, with increasing complexity and responsibility. 
• Prior experience in a management role with a total of 15 or more team members including experience administering performance reviews, coaching, and disciplinary action, as well as conducting interviews/hiring processes and making final determination.
• Master’s Degree from an accredited institution.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $119,900 - $183,430

• All Other Locations (within approved locations): $102,600 - $156,655

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.