Vp Or Dir Of Health Plan Operations Jobs

Have successfully proven remote-work time management skills

Assist members with questions regarding the Firefly Health Plan; Provider network, medications, prior authorizations, and Care-Pass requirements

Furnish benefits, claim status, eligibility checks, etc. to Providers on an Inbound and Outbound call basis.

Execute courteous, accurate, and prompt follow-up with customers by utilizing worklists to successfully manage daily tasks

Have excellent communication skills and love delivering great service to people, often at stressful moments in their health journey

Have experience using digital technology to improve service delivery

Strong organizational skills and a passion for establishing robust, logical processes in order to drive accountability and productivity

5 +years of major Division 1 or professional experience preferably in basketball

Must possess excellent leadership and communication skills.

Collaborate on all strength and conditioning activities, including the development of player specific programs

Communicate effectively with Head Coach and executive staff to maximize team performance while being mindful of health issues and concerns.

Collaborate with nutritionist and other resources to educate players and empower them to make positive and effective diet and supplement choices.

Report sales activity to management as required.

Perform or assist with any operations, as required to maintain workflow and to meet schedules and quality requirements.

Bachelor's degree or multiple years of Technology or PBM equivalent/relevant experience is required.

Interaction with key influencers as needed which may include Brokers/Consultants as directed.

Participate in and perform analysis of opportunities, potential client needs and objectives that fit corporate goals and objectives.

Delivery of Corporate Business Model and Value Proposition to prospects via phone call, email, conferences, speaking engagements, demos, and presentations.

Manage enrollment data and data systems including data transfers and the development and management of systems to meet PACE programmatic requirements

Manage and provide oversight to our TPA, PBM, pharmacy services, and other key vendors, including claims management, issue resolution, and receivables/payables

Experience in corporate finance, venture-backed startups, private equity, investment banking, or other finance-focused roles in high-growth and entrepreneurial environments

Prior experience building from the ground up or scaling a Finance & Accounting function at a high-growth healthcare organization preferred

Los Angeles preferred; relocation benefits offered if willing to reside in the Los Angeles metro area

Develop policies and procedures that meet applicable PACE program requirements

Benefits & Wellness Program including generous Time Off

Develop and manage technology budgets for the health plan, ensuring that resources are allocated effectively to meet the organization's needs.

Excellent leadership, interpersonal, and communication skills.

Ability to effectively manage budgets and resources to meet the needs of the organization

Strong problem-solving skills and the ability to think creatively to solve complex technical problems.

Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing

One (1) year of program management experience {is required/preferred}.

Works with all areas of the health plan, e.g., leadership, senior management, clinical, network, and quality improvement.

Three (3) years of experience in a Managed Care Organization (MCO), large hospital or healthcare system {is required/preferred}.

Experience implementing accreditation standards for a Managed Care Organization (MCO) such as Medicaid and the Affordable Care Act is preferred.

Coordinates with establishing set guidelines to meet NCQA accreditation requirements.

Assists with training and coaching to support understanding of accreditation standards and requirements.

Manage enrollment data and data systems including data transfers and the development and management of systems to meet PACE programmatic requirements

Manage and provide oversight to our TPA, PBM, pharmacy services, and other key vendors, including claims management, issue resolution, and receivables/payables

Experience in corporate finance, venture-backed startups, private equity, investment banking, or other finance-focused roles in high-growth and entrepreneurial environments

Prior experience building from the ground up or scaling a Finance & Accounting function at a high-growth healthcare organization preferred

Los Angeles preferred; relocation benefits offered if willing to reside in the Los Angeles metro area

Develop policies and procedures that meet applicable PACE program requirements