Manager, Operations - Member Services - Full Time - Days
At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA – the National Committee for Quality Assurance – for our Ohio HMO, Elite and Advantage products. We’re also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.
Assume responsibility and oversight of Member Services’ day-to-day operations to ensure continued membership retention, growth and regulatory compliance by providing quality personalized service to all internal and external customers in accordance with regulatory requirements. This leader needs to provide guidance and mentorship to department team leads as well as support to the AVP so that the AVP may be less involved in daily oversight and detailed decision making, and more focused on strategic path of Member Services.
1. Ensure direct reports are managing their staff and are effectuating day-to-day operations in compliance with all governing, regulatory, and accrediting bodies (CMS, ODM, ODI, NCQA, etc.). This includes ensuring the Regulatory Team Lead is organizing preparation for audits, ensuring the Quality & Training Team Lead is adjusting call representative resources appropriately across teams in real time, etc. <br />
2. Provide annual performance appraisals for direct reports along with documented counseling/disciplinary procedures.
3. Oversee staff to ensure distribution of and utilization of Member Service statistics to key stakeholders. Work to ensure operational efficiencies and maximize usefulness of analytical reporting.
4. Coordinate necessary team meetings, and one-on-one meetings with staff to ensure continuous process improvement for the department as well as professional growth. Collaborate with leaders across Paramount to find and maximize synergies for any collaborative processes.
5. Assist AVP to encourage department staff participation in department initiatives and identify concerns and assist in the implementation and evaluation of action plans. Provide insight and suggestions for improvement across the department to AVP.
6. Provide recommendations in the selection of new associates through participation in the interview process.
- Education + Years of experience: Bachelor’s degree in Health Care Administration, Business or related fields [MBA encouraged] plus 5 years experience in healthcare OR 12+ years’ experience in healthcare-related Customer Service, including 5 years in a leadership position without a Bachelor’s degree.
- Skills: Ability to work independently and plan/coordinate/organize multiple priorities; strong leadership & management characteristics including ability to listen well to multiple points of view, provide constructive criticism, excellent problem-solving skills, and ability to make decisions independently; Ability to maintain confidential information.
- Physical Demands: Ability to communicate on telephone and move between company work stations/departments; ability to operate general office equipment, including computers.
ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact firstname.lastname@example.org
Equal Opportunity Employer/Drug-Free Workplace
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