Senior Director, Operations

Come Grow With Us
At Gold Coast Health Plan, we are driven to create the health plan of the future - today. We are disrupting the conventions of the health care industry by creating and applying leading-edge solutions to its many challenges.

Working at Gold Coast Health Plan means working alongside a team of committed individuals who are reshaping the organization and redefining how the needs of the whole person - health, health care, and social services and supports - are met. We are seeking collaborators, innovators, and those who are driven to be their very best.

If you are looking for a career of purpose and are passionate about having an impact on society's health care challenges, then Gold Coast Health Plan is where you should be. Here, you will be challenged and rewarded in equal measure.

About this role:

POSITION SUMMARY
The Senior Director of Operations is a strategic leader that can direct and oversee Operations which includes the management of daily operations for Gold Coast Health Plan's (GHCP) as well as various outsourced services. The Senior Director of Operations reports directly to the Chief Operating Officer and plays a key leadership role, interacting with all levels of GCHP staff and Commissioners and external stakeholders, including regulators and legal counsel. This position is also expected to establish and maintain a high performing staff and communicate business results in a clear, concise and easily understood way in both written and verbal communication forms.

Additionally, this role is responsible for ensuring robust Quality Assurance practices across all operational functions, including the development and implementation of performance monitoring systems, compliance audits, and continuous improvement initiatives to maintain service excellence and regulatory adherence.

Reasonable Accommodations Statement
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

ESSENTIAL FUNCTIONS

Job Function & Responsibilities

* Oversee the integration of operational departments in order to maximize the effective use of all resources towards meeting established goals, compliance and quality requirements, and policies and procedures.
* Facilitate data-driven decision making across operational areas that leads to meaningful actions.
* Responsible to participate in and oversee operational health plan internal & external audits/assessments, responses, and corrective action plans in conjunction with the compliance department.
* Review operations metric and quality reports and analyze performance reports.
* Act as the primary liaison/consultant between outsourced operations vendor and the GCHP
* Effectively organizes communication content and formats analyses to facilitate understanding and decision making for GCHP senior leaders
* Coordinates the production, development and delivery of materials for any outsourced vendors joint operating meetings as well as collaborate with operational departments on the development and implementation of dashboards, scorecards, status reports for purposes of performance and analytical review
* Work closely with staff, vendors and peers to set goals, clearly define operations, and develop appropriate performance standards, metrics and reporting tools. Monitor Service Level Agreements and initiate any financial or operational corrective action plans.
* Implement new initiatives and resolve problems that cross multiple departments by forming ad-hoc workgroups and assessing intangible variables, automated processes, manual workflows, and impact to providers and members.
* Managing and providing support for projects related to Operations
* Develops and maintains policies and procedures to meet goals and ensure regulatory/contractual compliance; collaborates in managing regulatory audits and inquiries.
* Providing on-going development of the staff through mentoring and training including performance reviews, mentoring, and goal setting
* Develop and direct leadership development and training, including continuous improvement of knowledge and skill levels of all assigned staff
* Managing multiple initiatives at the same time using project management and communication skills.
* Maintaining effective professional relationships internally and externally
* Collaborate with internal and external customers and stakeholders to resolve issues and enhance relationships. Ensures the organization and its mission, programs, products and services are consistently presented in a strong, positive image.
* Monitoring and analyzing major vendors financial health to ensure contractual compliance
* Performing other duties and assignments as assigned

MINIMUM QUALIFICATIONS

Education & Experience:
* Bachelor's Degree (four-year college or technical school), Field of Study: Business, Finance, Actuarial Science, Accounting or related field
* Equivalent In lieu of degree: Will accept 4 years of experience in any combination of academic education, professional training, or work experience, which demonstrates the ability to perform the duties of the position.

KNOWLEDGE, SKILLS & ABILITIES
Preferred Qualifications:
* Working knowledge of
o Health Plan Operations, Managed Care and Risk Bearing Organizations.
o Medicaid/Medicare knowledge
* Master's Degree, Field of Study: Business Administration (MBA)

Technology & Software Skills: Advanced computer skills in MS Office products.

Certifications & Licenses: A valid and current Driver's License, Auto Insurance, and professional licensure(s)

Competency Statements
* Management Skills - Ability to organize and direct oneself and effectively supervise others.
* Business Acumen - Ability to grasp and understand business concepts and issues.
* Decision Making - Ability to make critical decisions while following company procedures.
* Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.
* Interpersonal - Ability to get along well with a variety of personalities and individuals.
* Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
* Time Management - Ability to utilize the available time to organize and complete work within given deadlines.
* Consensus Building - Ability to bring about group solidarity to achieve a goal.
* Relationship Building - Ability to effectively build relationships with customers and co-workers.
* Presentation Skills - Ability to effectively present information publicly.
* Delegating Responsibility - Ability to allocate authority and/or task responsibility to appropriate people.
* Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.
* Strategic Planning - Ability to develop a vision for the future and create a culture in which the long-range goals can be achieved.
* Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.
* Judgment - The ability to formulate a sound decision using the available information.
* Communication, Oral - Ability to communicate effectively with others using the spoken word.
* Communication, Written - Ability to communicate in writing clearly and concisely.
* Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.

PHYSICAL DEMANDS

O (Occasionally) Position requires this activity up to 33% of the time (0 - 2.5+ hrs/day)
F (Frequently) Position requires this activity from 33% - 66% of the time (2.5 - 5.5+ hrs/day)
C (Constantly) Position requires this activity more than 66% of the time (5.5+ hrs/day)

Stand O
Walk F
Sit C
Manually Manipulate C
Reach Outward O
Grasp F
Lift 10 -20lbs O
Carry 10-20lbs O

The estimated pay range for the position is:

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.