Director Operations Member Services Los Angeles, CA
Provides overall managementand direction at the med center for Member Services staff. Oversight responsibility of case processing,and quality of information and services provided by staff to clientele, to minimize the financial liability for the organization, and maximize prudent stewardship of member dues. Ensures contract integrity for the member and for KP. Educates customers, colleagues and community about KP's services and benefits. Builds relationships and collaborates w/ a variety of internal and external clients to develop strategies, action plans and member-focused systems to support business objectives and the joint vision of KFH/HP and the medical group.
Essential Functions:
- Provides leadership for member services at the med center and medical offices for designated facilities, including budgetary, compliance, service and quality oversight
- Hires, supervises, coaches/trains and develops staff who handle sensitive and multi-faceted member issues and requests
- Oversees the daily ops of the member services dept, including linkage w/ auditing, training and analyst work to best meet the needs of staff, members, key stakeholders, and leadership
- Acts as key liaison w/ the med group; develops programs and service improvements in conjunction w/ key med group personnel, managers, and physicians, to improve member experience and resolve member issues as quickly and effectively as possible
- Handles high risk issues by managing timely communication w/ medical facilities
- Provides ongoing information, reports and recommendations to facility departments and physician chiefs related to data analysis and provision of reports and information related to services and concerns that arise in specific departments
- Fosters a service oriented work environment w/ an emphasis on dedication to serving members, affording respect to individuals, achievement of highest standards of quality, identifying and supporting opportunities for innovation, supporting teamwork and implementing policies and practices that reflect the vision of KP
- Identifies member-system conflict in an effort to prevent professional liability, minimize financial penalties to the organization, and retain satisfied members
- Negotiates and works collaboratively w/ facility staff and applicable regional departments to reach satisfactory service solutions to issues that optimize member experience w/ service
- Works directly with, and fosters collaborative working practices between local member services and the correspondence center(s), applicable regional departments, and other departments at the med center
- Ensures that staff provide timely and thorough responses to members, their physicians, authorized representatives regarding the Health Plan's response to complaints and grievances that are handled at the med center level
- Collaborates effectively w/ units in the Member Services Org, and Health Plan units to ensure compliance w/ regulatory and accreditation standards, to drive consistency in communication and decision making and to promote and protect the rights and responsibilities of Health Plan members
- Collaborates w/ various internal departments to review data, develop reports and identify actionable items related to KP performance in key areas of regulatory focus
- Provides recommendations on external environment and internal practices to leadership w/ relation to risk mitigation
- Manages departmental budget to meet or exceed organizational goals and provide optimal departmental operations
- Participates in regulatory and accreditation agencies' audits and surveys related to the complaint and grievances
- Provides reports required by the HPRS dept
Qualifications:
Basic Qualifications:
- Bachelor's Degree or equivalent experience in a related field.
- Master's Degree preferred.
- Five (5) years management/leadership experience in a complex healthcare (preferably HMO) or service-oriented organization.
- Significant experience/knowledgeworking with accreditation and regulatory agencies and/or preparing information for regulatory audits as requested, (including, but not limited to Dept of Health Services (DHS), Department of Managed Healthcare (DMHC), and National Committee for Quality Assurance (NCQA) and Center for Medicare/Medicaid Services (CMS).
- Significant experience in customer service improvement and process redesign, with openness to creative and innovative approaches to providing service, including cultural sensitivity, respect and polite communication with patients and all clientele.
- Excellent presentation/public speaking skills and experience.
- Demonstrated management and leadership skills, including working with varied levels of staff, budgeting, delegation, staff development, coaching, resource allocation planning, and performance management.
- Demonstrated ability in development of team focus, partnership, service orientation, influence and change leadership.
- Demonstrated expertise in results orientation, taking initiative.
- Demonstrated knowledge regarding Health Care regulation and compliance standards, internal policies and procedures.
- Outstanding interpersonal/communication skills with ability to effectively partner with a wide group of stakeholders, including professional and medical staff.
- Demonstrated awareness in emotional intelligence as modeled in day-to day leadership responsibilities.
- Ability to use sound judgment and handle potentially charged issues independently and with knowledge and ability to escalate and obtain assistance when needed.
- Excellent investigation, problem solving and documentation skills preferred.
- PC Skills/computer literacy (MS Office: Word, Excel, and PowerPoint).
- General working knowledge of Kaiser Permanente Health Plan benefits plans/contracts/systems.
- Proven ability and commitment to work collaboratively in a Labor Management Partnership.
Preferred Qualifications:
- Healthcare experience strongly preferred.
- Member Services experience a plus
Submit Now Click here for additonal requirements