Chief Operating Officer / Job Req 956566674

Hybrid: Applicants must be a California resident as of their first day of employment.

PRINCIPAL RESPONSIBILITIES:

The Chief Operating Officer (COO) serves as a member of the executive team and contributes to strategic planning for the organization. The COO is responsible for the ongoing operations of Alliance programs to ensure the organization achieves its goals and objectives. This position is accountable to the Chief Executive Officer for the implementation of corporate policies/directives and recommends any changes needed in administration, operation, or policy. The incumbent is a key leader within the health plan and has the authority to enhance internal processes and organizational infrastructure that will allow Alameda Alliance for Health (AAH) to continue to grow and fulfill its mission. The COO oversees the following functions: Member Services, Claims, Provider Services, Grievance & Appeals, Credentialing, Communications, Community Outreach, Behavioral Health and Long Term Care Operations, Medicare Operations, Facilities, and Project Management Office.

Principal responsibilities include:

• Champion and communicate the AAH mission and vision internally and externally. Provide effective strategic and tactical leadership.
• Advance the company's mission and operational effectiveness through executive supervision of planning, implementation, and monitoring of departments' operations, work plans, and processes.
• Translate business vision and strategy into operational strategies.
• Set strategies, goals, programs, best practices, and compliance improvement projects for each function to improve operational performance.
• Act with integrity, honesty, and fairness, remaining mindful of the duty of trust AAH has to its employees, providers, vendors, and members.
• Lead the change management process to ensure consistent and seamless adaptation by management and staff regarding AAH policy, practices, and procedures. Proactively support his/her direct reports and colleagues in adapting to changes in the workplace.
• Challenge the status quo, bring in fresh ideas, and work to establish credibility and trust in all operational areas.
• Achieve all regulator established and internal operating metrics.
• Serve as an effective member of the senior leadership team to achieve organizational goals.
• Identify prospective business process improvements. Develop, implement, and utilize meaningful, appropriate performance metrics that: support the AAH mission; align with AAH business goals and objectives; maximize business results; and address the critical strategic and/or tactical issues and concerns facing AAH. Provide thoughtful and thorough analyses and recommendations.
• Oversee the development and retention of reliable, customer service-oriented, high-performing departmental teams. Hire, mentor, train, and retain highly qualified, talented staff.
• Establish appropriate, well-defined departmental performance competencies and metrics. .
• Contribute actively, prudently, and responsibly to the overall financial viability of the organization, the management of its resources, and the development and management of the organization's annual and capital budgets.
• Model professional behavior/conduct that remains in concert with the AAH culture and business values. Lead by example, whether in group or individual meetings with AAH CEO, Board Members, staff, providers, members, or employers.
• Develop and execute plans to improve internal and inter-segment operational efficiencies.
• Assess operating business risks/opportunities and identify strategies to mitigate/capitalize as appropriate.
• Develop and implement tools for monitoring and evaluating performance objectives.
• Establish member growth and retention.
• Performs other duties and special projects and duties as assigned.

ESSENTIAL FUNCTIONS OF THE JOB

• Strategic planning and oversight of all departments within Operations to ensure health plan operations are running smoothly.
• Responsible for the accurate and timely provision of information and documentation within the Customer Service, Member Eligibility Management, Claims, and Provider Network Operations Departments at AAH. These departments are the key points of contact for members and providers and serve as the primary intake for eligibility and areas of interchange between the Plan and its partners.
• Provides strategic management oversight in developing, implementing, directing, and monitoring the Alliance's Medicare Program(s), including strategy development, product design, market positioning, and ensures effective ongoing operational management
• Oversee the development, implementation, and updates of the Alliance's Annual Network Strategy and strategic plan.
• Accountable for maintaining provider agreements and ensuring internal compliance with those agreements.
• Responsible for maintaining functional relationships with provider partners.
• Accountable for the appropriate deployment of Business Solutions resources to drive uptake and use of automated solutions and continuous improvement tools to streamline health plan operations.
• Ensure timely and effective communication with members and providers while meeting DHCS' and DMHC's regulatory and contractual requirements.
• Accountable for mitigating risk to AAH in administrative (non-provider) agreements.
• Champion excellent customer service and motivates staff to deliver outstanding service to both internal and external customers.
• Identify, implement, monitor, measure, and report on the appropriate performance goals and metrics aligned with and supportive of AAH strategic goals and objectives.
• Review and assess overall division function, including the core work, goals, and structure of each department, and oversee directors' development and implementation of short- and long-term planning to achieve strategic objectives and completion of annual department strategic planning related activities.
• Anticipate and manage changes throughout the organization, equipping staff and systems to adapt quickly.
• Establish forward-looking goals and deliver results.
• Structure business disciplines to facilitate quick and data-based decisions and ensure accountability for execution.
• Maximize operational linkages and leverage resources, collaboration, and efficiency among all departments within the company.
• Develop an effective Operations team through staff members' selection, training, evaluation, and development. Align people and resources with strategic priorities.
• Advance AAH's mission and operational effectiveness through executive supervision of planning, implementation, and monitoring of departments' operations, work plans, and processes.
• Supervise department leaders and Operations Directors in setting goals, objectives, and standards, implementing work plans, monitoring, and evaluating performance, and making corrective actions.
• Identify opportunities for efficient and effective operations within and between departments and organize cross-departmental solutions to business challenges.
• Anticipate and forecast industry trends affecting AAH.
• Set proactive goals and develop opportunities to improve the effectiveness of operations to benefit customer service, administrative quality, and operating efficiency.
• Participate in new business planning and development.
• Develop and maintain analytic reports and performance metrics related to strategic goals and projects.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Comply with the organization's Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

• Frequent and close visual work at desk or on a computer.
• Constant sitting and working at a desk.
• Frequent data entry using keyboard and/or mouse.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Occasional driving of automobiles.

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• Bachelors degree is required.
• Masters Degree in Health Administration preferred or equivalent work experience in Health plan or Medicaid/Medicare Managed Care can be substituted.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• Twelve years of progressive responsibility within the health care field should include experience in leading and managing direct reports.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Working knowledge of health care fiscal principles and operations.
• Strong analytical, communication and strategic thinking skills, with a proven ability to lead
• teams and manage complex operational processes. Working knowledge of managed care provider payment methods and contracting.
• Experience in using managed care concepts within public sector health delivery systems.
• Extensive experience with public assistance programs and public agencies, specifically working knowledge of the California Medi-Cal program and entitlement programs.
• Experience with Medicare Advantage Pro
• Proven ability to maintain an effective professional relationship with a Board of Governors.
• Possess strong interpersonal skills, excellent verbal, and written communication skills.
• Possess excellent people skills, with an ability to partner with a dynamic leadership team.
• Possess personal qualities of integrity, credibility, and commitment to the mission of AAH.
• Flexible and able to manage competing priorities; can work within an ambiguous, fast-moving environment, while also driving toward clarity and solutions; demonstrate resourcefulness in setting priorities and guiding investment in people and systems.

SALARY RANGE $357,240.00 - $535,849.60 ANNUALLY

The Alliance is an equal opportunity employer and makes all employment decisions on the basis of merit and business necessity. We strive to have the best-qualified person in every job. The Alliance prohibits unlawful discrimination against any employee or applicant for employment based on race, color, religious creed, sex, gender, transgender status, age, sexual orientation, national origin, ethnicity, citizenship, ancestry, religion, marital status, familial status, status as a victim of domestic violence, assault or stalking, military service/veteran status, physical or mental disability, genetic information, medical condition, employees requesting accommodation of a disability or religious belief, political affiliation or activities, or any other status protected by federal, state, or local laws.