Director of Core Systems Operations

Company: Metroplus Health Plan
Location: New York
Posted on: June 25, 2022

Job Description:

Empower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.About NYC Health + HospitalsMetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.Position Overview The Director of Core Systems Operations is responsible for evaluating operation processes and procedures for process improvement of MetroPlus Core Applications. Will work with claims editing applications and vendors, Claims Operations, Utilization Management, and Network Management to setup system edits. Job DescriptionOversee development and implementation of short/long term business objectivesDirect and support initiatives to focus on projects with plan wide benefit in accordance with corporate budgetary objectivesEnsure continuous delivery of IT services through oversight of service level agreements and monitoring of IT systems vendor performanceOversee functions performed by delegated vendor as it relates to benefit configuration, claims processing, provider setup and account payable systemManage activities and communications between key business stakeholders and Core System Vendor for implementation of new systems and optimization of current systemsDevelop and oversee SDLC methodology, including business requirements creation and sign off, Quality Assurance, User Acceptance Testing, Production and Postproduction activitiesAddress operational matters by working with business units to identify system solution to operational issuesParticipate and advise in new business/operational initiativesProvider guidance on current and future system capabilitiesCollaborate with operational areas and the system vendor to create system enhancement road mapIdentify areas of operational improvement, promote strategic relationships with business areas, vendor, governmental and partner organizationsWork with claims editing vendors, Claims Operations, Utilization Management, and Network Management to setup system edit to increase medical cost savings Facilitate improvement of the payment transaction process by interacting with providers and finance teamManage project implementation of upgrades and new products as it relates to Core SystemsManage production processes, regulatory reports submission and provider directory activitiesMinimum QualificationsBachelor's Degree from an accredited college or university in Information Systems, Computer Science, Healthcare IT or related fieldA minimum of 15 years Data Processing related experience Healthcare IT experience required Project Management and Staff Supervision a plusProfessional CompetenciesIntegrity and TrustCustomer FocusFunctional/Technical skillsWritten/Oral Communication

Keywords: Metroplus Health Plan, New York , Director of Core Systems Operations, Executive , New York, New York