Apply on Employer Site

Fidelis Care - New York · 1 day ago

Vice President, Operations

New York, NY

Full-time

Hybrid

Senior Level, Lead/Staff

$185K/yr - $353K/yr

8+ years exp

Centene is transforming the health of our communities one person at a time. In this role, you will oversee operations, procurement opportunities, and new product implementations for assigned business units to meet strategic objectives.

AssociationCommunitiesHealth CareInsurance

Responsibilities

Oversee operations, procurement opportunities, new product implementations and initiatives for assigned business unit or product line to meet strategic objectives

Responsible for day to day operations of assigned business unit or product line ensuring product strategy developed and key priorities are implemented

Execute projects and activities to ensure health plans are meeting all product goals

Provide day to day oversight of assigned business unit or product line

Collaborate with multiple stakeholders and business unit leadership to establish strategic vision, operational objectives, and policies and procedures ensuring compliance with state and federal contracts, related laws, regulations and executive orders

Deep understanding of managed care models (HMO, PPO, Medicaid, Medicare Advantage, Duals, SNPs)

Familiarity with healthcare laws, reimbursement models, and value-based care initiatives

Perform duties as senior liaison between product line, other business units, corporate, and external stakeholders related to operational areas

Oversee day-to-day operations including claims processing, provider network management, member services, utilization management, and quality improvement

Ensure compliance with CMS, NCQA, HIPAA, and other regulatory bodies

Oversee implementation and optimization of health plan operations systems (e.g., claims adjudication platforms, CRM tools)

Drive digital transformation initiatives to streamline operations

Understand and execute on key operational needs of assigned business unit or product lines

Oversight of relevant corporate business units to ensure the development and implementation of operational work processes and systems within product lines to senior management

Act as lead on new product implementations

Qualification

Managed care modelsHealthcare lawsOperational oversightClaims processingDigital transformationBusiness developmentRegulatory complianceStakeholder collaboration