Director of Core Systems Operations
Company: Metroplus Health Plan
Location: New York
Posted on: June 25, 2022
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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
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