Senior Director of IT Core Systems Operations (Health Plan), New York

Senior Director of IT Core Systems Operations (Health Plan)

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MetroPlusHealth 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's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Senior Director of IT Core Systems is responsible for evaluating operational processes and procedures for process improvement of MetroPlusHealth Core Applications. This position will work with our application vendors as well as Claims Operations, Utilization Management, Network Management, and other operational areas to optimize the use of core systems supported by IT.

Job Description

Oversee development and implementation of short/long term business objectives
Direct and support initiatives to focus on projects with plan wide benefit in accordance with corporate budgetary objectives
Ensure continuous delivery of IT services through oversight of service level agreements and monitoring of IT systems vendor performance
Oversee functions performed by delegated vendor as it relates to benefit configuration, claims processing, provider setup and account payable system
Manage activities and communications between key business stakeholders and Core System Vendor for implementation of new systems and optimization of current systems
Develop and oversee SDLC methodology, including business requirements creation and sign off, Quality Assurance, User Acceptance Testing, Production and Postproduction activities
Address operational matters by working with business units to identify system solution to operational issues
Participate and advise in new business/operational initiatives
Provider guidance on current and future system capabilities
Collaborate with operational areas and the system vendor to create system enhancement road map
Identify areas of operational improvement, promote strategic relationships with business areas, vendor, governmental and partner organizations
Work with claims editing vendors, Claims Operations, Utilization Management, and Network Management to set up system edits to increase medical cost savings
Facilitate improvement of the payment transaction process by interacting with providers and finance team
Manage project implementation of upgrades and new products as it relates to Core Systems
Manage production processes, regulatory reports submission and provider directory activities

Minimum Qualifications

Bachelor's Degree from an accredited college or university in Information Systems, Computer Science, Healthcare IT or related field
A minimum of 10 years' systems/operations management-related experience
Healthcare IT experience required
Project Management and Staff Supervision a plus

Professional Competencies

Integrity and Trust
Customer Focus
Functional/Technical skills
Written/Oral Communication

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Location:: New York