Senior Director, Health Plan Services & Administration

Responsible for end to end management of people, processes and systems supporting the Georgia Region's Health Plan Services & Administration (HPSA) functions which include, but are not limited to: Benefits and Membership Administration, Claims Administration, Contact Centers, Quality Assurance, Audits, Appeals, Medical Records Administration, Data Management and Telephony Support. This includes accountability for the performance of any and all national 'shared services' related to these administrative functions. Responsible for enhancing and maintaining HPSA administrative functions for the Georgia Region. Provide leadership and subject matter expertise related to development of compliant, comprehensive health plan administration across the Georgia Region. Work with regional and national leaders to develop a collaborative strategy and infrastructure to operationalize the strategy. Build a high performing team achieving operational excellence in key performance metrics; optimize service to members while minimizing administrative expenses assuring compliance with internal policies and state and federal regulations. Coordinate and champion projects while acting as a subject matter expert to establish program-wide standardized policies and processes based on best practices for the Georgia Region's health plan administration functions. Accountable for budget of $2 - 4 million in non-payroll expenses and supervision of 5 - 8 direct reports and 40 - 60 FTE's.Essential Responsibilities:Develops a high performing team as measured through achievement of benchmark process outcomes, audit and compliance results, financial goals and employee satisfaction. Recruit and build leadership and management talent throughout the HPSA operation. Ensure transparency on goals and performance improvement throughout areas of responsibility.Provides subject matter expertise in the functional areas of Benefits and Membership Administration, Claims Administration, Contact Centers, Quality Assurance, Audits, Appeals, Medical Records Administration, Data Management and Telephony Support.Ensures both strategy and implementation plans address internal controls, optimizing infrastructure to support strategic goals, ensuring transparency in project activities and costs related to such activities.Partners with a broad range of National and Regional leadership and staff including Medical Group operations to provide leadership, coordination, guidance, and influence to develop strategies and set strategic vision for best practice service administration.Identifies and builds consensus for facilitation of system and process standardization, utilization of best practices, work integration, change management, issue resolution, metric development and measurement, and communication related to the key components of the administrative service functions. Identifies improvement opportunities and lower costs while maintaining or improving customer service.Develops ongoing HPSA communication strategy for the KPGA Health Plan and Medical Group, Compliance, and numerous other management and non-management staff throughout the organization for delivery of regular updates, ensuring sharing of knowledge and implementation of business and technology systems across regions.Basic Qualifications:ExperienceMinimum twelve(12) years of progressive experience within the healthcare industry, including leadership/management experience, consulting and/or project management experience. EducationBachelor's degree in healthcare administration, finance or four (4) years of experience in a directly related field.High School Diploma or General Education Development (GED) required.License, Certification, RegistrationN/A.Additional Requirements:Experience in managing complex, large-scale projects and/or multiple departments and establishing detailed work plans and setting priorities.Familiarity with administrative information systems.Strong presentation skills, with experience of presenting and influencing Executive level leaders.Proven leadership skills that include influencing, efficiency and collaboration with a focus on results.Demonstrated understanding of the operations and/or business of Healthcare Systems.Successful experience in achieving results in a matrix organization.Thorough knowledge of complex project management processes, tools, techniques and methodologies to lead large scale efforts.Knowledge or exposure to Epic Systems.Strong leadership skills; ability to recruit talent and develop teams.Business expertise, financial acumen and interpersonal skills to effectively work through a matrix, complex and political organization to influence and facilitate sustainable change.Strong expertise in administration / operations and knowledge of industry best practices.Preferred Qualifications:Minimum twelve (12) years of consulting, project management, and/or general management experience in a health plan, managed care organization, medical group or hospital setting preferred.Masters degree in Business Administration, Public Health, Health Administration or six (6) years of experience in a directly related field.COMPANY: KAISERTITLE: Senior Director, Health Plan Services & AdministrationLOCATION: Atlanta, GeorgiaREQNUMBER: 1072935External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.