Upvote
Downvote
Director, Health Plan Operations Medicaid - REMOTE in Michigan
Share Job
- Suggest Revision
Remote
- Under the leadership of the VP, Health Plan Operations, plans, organizes, staffs, and coordinates the operations of the health plan for the Medicaid , CHIP, Marketplace, MMP and Medicare lines of business.
- Serves alongside the VP, Health Plan Operations as liaison for MHI Operations, including: Claims, Configuration Information Management, Provider Data Management, Credentialing, Enrollment, and Contact Center Operations.
- Oversees the Plan's Provider Network Administration activities, specifically ensuring that corporate staff receive data to load correct provider, contract and benefit configuration to support accurate claims payment and for development of accurate provider directories.
- Coordinates activities and executes strategies to address opportunities to improve provider satisfaction and reduce operational risk in conjunction with Provider Services.
- Oversees the Member Appeals and Grievance process; completes analytics to identify trends; and executes strategies to improve member satisfaction.
Active Job
Updated TodaySimilar Job
Relevance
Active