Director, Member Services Operations

Job Summary: The southern California Local Member Service Department is a regionally based team with offices located throughout Southern California Medical Centers. While the work location for this position will be located around the LA basin, this Director role will primarily be responsible for overseeing Member Services Operations at Woodland Hills Medicalcenter and West LA Medical Center. This role will be expected and must be able to travel to additional sites/locations as needed to support operations/business objectives. Provides leadership, overall management, strategic direction, and support to the Local Member Services professional staff, across multiple sites. Responsible for Member Services daily operations, initiatives, oversight of case processing, issue resolution, quality of information and service provided by staff to both internal and external customers. Support and represent Kaiser Foundation Health Plan Member Services, and strategize with Regional and Local leadership, facility personnel, and physicians to minimize the financial risk to the organization and ensure contract integrity for our members as well as Kaiser Permanente. Provide performance based consulting to department management and facilities throughout Northern California. Provide service recovery in order to assist in the retention of our members. Drive the mission and business results for Kaiser Permanente while meeting budgetary guidelines to ensure responsible stewardship of our members dues. Directs case management activities across multiple units within a department by proposing the strategic direction for process inefficiencies. Ensures that case management and resolution activities are performed in compliance with internal and external rules and regulations. Develops long-term strategies for improving case research. Forecasts and develops strategic plans for high priority incident case resolution. Drives exceptional customer and member services through training, process, and procedures. Integrates expert knowledge of the incident management process, relevant laws, regulations, statutes, and organization-wide initiatives to identify and address operational gaps that contribute to member and provider dissatisfaction, unnecessary appeals cases, or group retention issues. Evaluates data and identifies trends to conduct root cause analysis, identify stakeholders with whom to improve consumer experience, and implement operational solutions. Influences the creation of policies to reflect operational changes and ensure effective change management. Essential Responsibilities: Prepares individuals for growth opportunities and advancement; builds internal collaborative networks for self and others. Solicits and acts at performance feedback; drives collaboration to set goals and provide open feedback and coaching to foster performance improvement. Demonstrates continuous learning; oversees the recruitment, selection, and development of talent; ensures performance management guidelines and expectations to achieve business needs. Stays up to date with organizational best practices, processes, benchmarks, and industry trends; shares best practices within and across teams. Motivates and empowers teams; maintains a highly skilled and engaged workforce by aligning resource plans with business objectives. Provides guidance when difficult decisions need to be made; creates opportunities for expanded scope of decision making and impact. Oversees the operation of multiple units within a department by identifying member and operational needs; ensures the management of work assignment completion; translates business strategy into actionable business requirements; ensures products and/or services meet member requirements and expectations while aligning with organizational strategies. Gains cross-functional support for business plans and priorities; assumes responsibility for decision making; sets standards, measures progress, and fosters resolution of escalated issues. Communicates goals and objectives; analyzes resources, costs, and forecasts and incorporates them into business plans; prioritizes and distributes resources. Removes obstacles that impact performance; guides performance and develops contingency plans accordingly; ensures teams accomplish business objectives. Directs member incident case management by: developing and recommending long-term strategic initiatives and operational vision for incidence case management using data and trends from the case tracking database; proposing the strategic direction for addressing process inefficiencies in case management, such as case volumes that are too high or low, across multiple teams or regions, as well as processing highly complex or high risk cases and managing highly complex teams across all lines of business; and ensuring that case management activities are performed in compliance with internal and external rules and regulations across multiple units within a department. Promotes member incident case research by: developing long-term strategies for improving and addressing process inefficiencies related to incident case research activities across members and customers for multiple units within a department. Determines strategies for the resolution of member incident cases by: forecasting and developing strategic plans to address high priority incident resolution needs; and ensuring processes for incident resolution are effective and compliant with internal and external rules across multiple units within a department. Promotes customer service by: developing and improving strategies to ensure overall member communication (i.e. information provided to members, customers, or other stakeholders from staff related to concerns/incidents) is accurate, timely, and meets or exceeds program wide and consumer expectations; and driving exceptional customer and member service through establishing training, processes, and procedures that address cases involving highly charged, sometimes emotional situations and updating communication processes for incident resolution across multiple units within a department to ensure effectiveness and compliance with internal and external rules and regulations. Improves case documentation efforts by: refining data collections processes to ensure that all relevant information to address cases is being gathered to ensure regulatory compliance, audit readiness, and that data can be used to drive upstream improvements; and developing strategic documentation process plans for multiple units in a department to ensure that all quality and regulatory standards are being met. Serves as a leader for operational improvement by: integrating expert knowledge of the incident management process, relevant laws, regulations, statutes, and organization-wide initiatives to identify and address operational gaps that contribute to member and provider dissatisfaction, unnecessary appeals cases, or group retention issues; evaluating data and identifying trends to conduct root cause analysis, identify stakeholders with whom to improve consumer experience, and implement operational solutions; and influencing the creation of policies to reflect operational changes and ensure effective change management across multiple units within a department. Minimum Qualifications: Minimum six (6) years of experience in customer service or a directly related field. Minimum two (2) years of experience managing operational or project budgets. Minimum three (3) years of experience in a leadership role with direct reports. Bachelors degree in Business Administration, Economics, Health Care Administration, Health Services, Communications, or related field AND minimum nine (9) years of experience in health care, health insurance, sales and marketing, or directly related field OR Minimum twelve (12) years of experience in health care, health insurance, sales and marketing, or a directly related field. #J-18808-Ljbffr Socket.dev