Job Description

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

* Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

* Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

* Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

* Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Skills / Requirements

JOB SUMMARY

The Vice President of Operations will provide strategic leadership and direction to various operational departments, including claims, enrollment, member services, provider relations, and network management. One of the primary objectives will be to optimize operational performance, enhance member experience, and drive organizational growth.

This role will collaborate closely with cross-functional teams, including finance, IT, and quality improvement, to develop and implement operational strategies that align with our overall business objectives. Additionally. This role will build and maintain strong relationships with key stakeholders, including government agencies, healthcare providers, and community organizations. The ability to effectively communicate and negotiate with these partners will be crucial in driving successful outcomes and promoting our mission of providing accessible and high-quality healthcare to our diverse member population.

JOB SPECIFICATIONS AND CORE COMPETENCIES
Strategic Planning:

  • Develop and execute strategic plans to drive operational excellence and achieve organizational goals.
  • Analyze market trends, regulatory changes, and competitive landscape to identify opportunities and risks.
  • Establish performance metrics and targets to monitor and evaluate operational performance.
  • Identify and implement process improvement initiatives to enhance efficiency and quality of services.
  • Collaborate with executive leadership to align operational strategies with overall business objectives.


Department Leadership & Management:

  • Provide leadership, guidance, and support to operational departments, including claims, enrollment, member services, provider relations, and network management.
  • Develop and manage department budgets, ensuring financial accountability and resource optimization.
  • Set clear performance goals and expectations for departmental managers and hold them accountable for results.
  • Foster a culture of continuous learning, collaboration, and employee development.
  • Ensure compliance with regulatory requirements and adherence to industry best practices.

Cross Functional Collaboration:

  • Collaborate with finance, IT, and quality improvement departments to align operational strategies and initiatives.
  • Foster strong relationships with government agencies, healthcare providers, and community organizations to enhance collaboration and partnerships.
  • Participate in cross-functional teams to develop and implement innovative solutions and process improvements.
  • Communicate effectively with internal and external stakeholders to ensure alignment and successful outcomes.
  • Support executive leadership in special projects and initiatives as needed.
  • Represent the organization in industry conferences, forums, and meetings.
  • Stay abreast of industry trends, policy changes, and emerging technologies to drive innovation and stay ahead of the curve.
  • Continuously monitor and assess operational risks, and develop and implement mitigation strategies.

QUALIFICATIONS:

  • Education/Specialized Training/Licensure: Bachelors degree in healthcare or business Administration or related field. Valid State Health and Life Insurance License required.
  • MBA, Master of Public Health, or Health Administration Preferred.
  • Work Experience (Years and Area): 10 years within a Patient Care or Managed Care organization. Contract negotiation, knowledge of federal, state, and local healthcare laws and regulations. Proficiency in budgeting, financial analysis, and cost management.
  • Management Experience (Years and Area): 5 years management experience
  • Software Proficiencies: Microsoft Office (Word, Excel, Outlook)

Application Instructions

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