Vice President of Operations

AMIDA CARE INC.•New York, NY

About The Position

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member. We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit http://www.amidacareny.org [http://www.amidacareny.org/] for more information about the Amida Care culture. We are actively seeking a highly motivated, innovative and experienced individual to join our team as the Vice President of Operations. Compensation will be commensurate with experience. Position Summary: In collaboration with and under the direction of the Chief Operating Officer, the Vice President of Operations is responsible for managing all hands-on operational aspects of the plan and will assist the COO in successfully meeting the goals of the organization. This executive role is responsible for the overall direction and administration of key operational departments, programs and services provided by the health plan.

Requirements

Bachelor’s degree combined with ten plus (10+) years of experience in Health Plan Operations and Information Technology.
Over ten (10) years of progressive Managed Care experience spanning claims, provider contracting, and vendor management.
Extensive background with New York State Medicaid in a health plan environment, including more than five (5) years in senior-level roles.
In-depth working knowledge of Medicaid regulatory reporting requirements (e.g., MMCOR, SNPOR) for the New York State Department of Health and CMS.
Strong analytical, innovative, and critical thinking skills.
Collaborative and inclusive leadership style. Open to feedback and considering new ideas and approaches.
Exceptional interpersonal and verbal/written communication skills.
Strong computer skills, including MS Office (EXCEL, Word, Power Point).
Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.

Responsibilities

The Vice President of Operations will provide leadership and administrative report to the Claims/Encounter, Reporting, Provider Services, Credentialing and Vendor Management Teams.
Responsible for ensuring a comprehensive cost efficient and accessible provider network that is contracted and linked to appropriate fee schedules.
Manages the end-to-end contracting process, including credentialing, outreach, recruitment, contract initiation, and provider services for all risk arrangements including Valure Based providers.
Proactively identifies risks and opportunities for improvement by utilizing a data driven mind set to solution and improve operations through automation and workflow redesign.
Provide leadership, management, and vision necessary to ensure that the company has the proper operational controls, administrative and reporting procedures, and people systems in place to effectively grow the organization and to ensure financial strength and operating efficiency.
Strategic though leader responsible for claims insights and analytics to drive efficiency and financial responsibility, are also critical aspects of the role.
Drives the development, negotiation, and execution of vendor contracts, including RFIs, RFPs, Statements of Work (SOWs), and final agreements, ensuring alignment with business, clinical, and financial goals.
Build and maintain relationships with key internal and external stakeholders to ensure the successful outcome of business objectives and goals.
Accountable for ensuring departmental compliance with contractual, regulatory, and corporate requirements, guidelines, and goals including turnaround times, timely submissions, and reporting.
Oversee implementation / project management both contractually and operationally for new vendors and third-party software outside of IT.
Ensures efficient processes and proper follow-up with our external vendors.
Development of key metrics and KPIS for operational effectiveness.
Oversee monitoring of the vendor process of to ensure and monitor process of timely submission and error corrections and resubmissions.
Responsible for the hiring and retention of quality staff and the on-going planning, monitoring, training, coaching, evaluation, and appraisal of staff performance and development to ensure successful achievement of goals and objectives.
Other duties as assigned.