Director, Operations (On-site)

Nexus Enterprises LLC•Schertz, TX

1d•Onsite

About The Position

The Director, Operations works closely with the VP, Operations to ensure that the organization, as well as its subsidiaries, is well-positioned in a rapidly evolving and competitive environment by being an agent for ongoing organizational change. This position is directly responsible for the processes and functions of the daily administrative workflow for Nexus Enterprises, LLC, and its subsidiary, ProPeer Resources, LLC. Overseeing daily operations, including supervising the operational management team, and ensuring that staff is performing all aspects of the Utilization Review (UR) and the Independent Review Organization (IRO) business lines. The goal is to achieve clinical, financial, and utilization goals through effective management, communication, and role modeling. The Director, Operations is responsible for carrying out assignments to assure success in financial management, human resources management, leadership, quality, and operational management objectives, as well as participating in program development and unit performance improvement. The Director, Operations should consistently demonstrate the core values of Nexus Enterprises, LLC and serve as a role model to other team members.

Requirements

Current knowledge of utilization review processes and managed care
Knowledge of or ability to learn financial management related to Utilization Management (UM) function and reporting, quality improvement processes, and human resources management
Ability to effectively monitor, evaluate, and administer the resources of each assigned area and make substantiated recommendations regarding resource allocation needs for future planning purposes
Ability to identify trends through analysis of practices to improve the overall utilization of resources and cost containment
Ability to communicate those trends found through analytical study using a variety of reporting mediums
Experienced in building and leading high-performing teams through effective recruitment, training, and motivation, aligning staffing strategies with profitability and growth objectives
Excels in building and sustaining strong professional relationships through a poised demeanor and assertive communication style that is both respectful and collaborative
Demonstrated ability to problem-solve complex, multifaceted situations
Ability to engage easily in abstract thought
Keen sense of urgency, exceptional organizational skills, and the ability to prioritize tasks in a fast-paced environment
Strong analytical, numerical, and reasoning abilities
Participative management type (advocates team concept)
Demonstrates exceptional judgment and quickly identifies optimal solutions, aligning with business objectives
Ability to train, mentor, and motivate team members and have excellent collaborative skills
Communicate effectively (both verbally and in writing) with administrators, co-workers, and other personnel when providing information and/or services
Establish a team-oriented, efficient, and effective work environment
Responsible for the performance management review process for all direct reports
Hold regularly scheduled meetings with team members to keep them informed, motivated, and review/streamline processes, as well as discuss opportunities and concerns
Ability to make recommendations for practice change to improve the Utilization Management efforts of the department
Ability to represent Utilization Management in organizational committees as assigned
Excellent relationship management skills
Ability to establish credibility and be decisive
Able to recognize and support the organization’s preferences and priorities
Results-oriented with the ability to balance other business considerations
Knowledge of multi-state workers’ compensation systems
Computer literacy in Microsoft Office products and database programs
Ability to construct grammatically correct reports using standard medical terminology
Bachelor’s Degree or equivalent work experience
Minimum of 3 years as a Director in a Utilization Management (UM) organization

Nice To Haves

Strong technical sourcing abilities and experience with a fast-growing start-up company are a plus

Responsibilities

Reviews performance against operating plans and standards & provides reports to subordinates or interpretation of results, and approves changes in direction
Presents monthly and ad hoc reports on performance
Develops and presents matters requiring a decision outside of the authorization level
Develop and recommend objectives in each area of Operations
Develops specific short and long-term plans, processes, and programs with the supporting budget requests and financial estimates
Coordinates and collaborates with other departments of the organization in establishing and fulfilling responsibilities
Reviews operational projects involving major changes within the organization’s functional areas
Develops plans for new areas of technology for the operational function, along with sufficient planning for areas that support the mission of the organization within Operations
Establish objectives and processes governing the performance of assigned activities and issue specific annual objectives to immediate subordinates
Reviews objectives of the Operations Management Team
Selects and maintains qualified personnel in all positions reporting to Operations and provides the necessary coordination of activities
Identifies training needs, initiates development of subordinates, and recommends effective personnel action
Participates in the development and management of department budgets and productivity targets
Manages human resources utilization, promotes team member satisfaction, supports staff development, and utilizes the progressive discipline process when appropriate
Ensures that workflow operations complete client-specified work according to the client specifications
Participate in quality improvement processes and ensure implementation of regulatory standards
Research interdepartmental problems/issues and take corrective action promptly, and promote respectful, responsive communication between departments
Establishes, evaluates, and monitors UR processes, policies, and procedures
Support company and departmental QA/QI initiatives
Maintains appropriate communications within areas of responsibility
Keeps subordinates/team members informed as to the organization’s plans and progress
Coordinates activities of assigned responsibilities with outside departments
Seeks mutual agreement on challenges involving coordination and collaboration
Consults with all segments of management responsible for policy or action
Ensures compliance within the area of responsibility
Makes recommendations for improving the effectiveness of policies and procedures
Reviews and endorses or revises budget proposals received from direct reports. Submits budgets for assigned activities in accordance with the budget procedure
Provides orientation and on-the-job training for subordinates and ensures that the authority and responsibility for each position are defined and understood
Ensures that the duties, responsibilities, authority, and accountability of all direct subordinates are defined and understood
Assumes other activities and responsibilities from time to time as directed