Director, Healthcare Business Administration

JOB TITLE: Director, Healthcare Business Administration

CLASSIFICATION: Exempt

Actual offers will be determined by the candidate's creditable years of experience in conjunction with internal equity considerations and based on the organization's current compensation practices.

JOB SUMMARY:

Works within the vision, mission, and philosophy of the agency. Reporting to the SVP of Strategy, Innovation & Growth with full-delegated authority to be the Business Owner of the Agency’s Healthcare Business Applications, Systems, and Business Processes. The Director of Healthcare Relations will be responsible for the development of the business practice and infrastructure of this new Healthcare business line. This position will work under direction of the Strategy and Corporate Business Development Function and in close collaboration with the New Business Regional Executive Director, Chief Financial Officer, and Clinical Administration management. This position will also serve as a liaison for other new healthcare service lines ensuring alignment of mission and operations across functional areas. This position in an integral part of the Business Development and Strategy leadership team to oversee and assist in delivering on project initiatives for the Agency for both short- and long-term strategic planning. The Director, Healthcare Business Administration is a senior level position that is responsible for key decision making, coordination, and collaboration and could supervise direct reports within the New Business Department as necessary.

ESSENTIAL FUNCTIONS/JOB DUTIES:

Healthplan New Business and Administrative Management

• Responsible for driving health plan business operations projects and initiatives
• Establish and maintain primary relationships with key Healthcare leaders including industry, healthplans and providers
• Directs the design and implementation of the new Healthcare Business Line in collaboration with internal and external partners that is consistent with the strategic plan.
• Designs, develops, implements systems and processes and KPI's and ensure positive outcomes both in clinical practices and fiscal results
• Establish and maintain subject matter expertise in service line serving as the SME for all aspects of the business
• Ensure systems and processes are in compliance with laws and regulations and that internal systems maintain compliance with appropriate clinical and operational standards
• Support Regional Executive Directors in partnership with the New Business RED to identify health plan-related business opportunities related to new business line and consistent with the agency's strategic goals.
• Foster and maintain collaborative relationships with health plan business partners
• Support REDs to monitor KPI of health plan programs.

Health Plan Contracting

• Design and own the system for maintaining rates for the Agency
• Lead contract negotiations with healthplans and related payors in partnership with New Business Analyst
• Responsible for maintaining Usual and Customary rates and coordination of rates across new business lines.
• Work with executive leadership for Board review of rates.
• Responsible for collaborating with Clinical Administration for credentialing process

Payer Relations

• Responsible for creating, maintaining, and expanding important relationships with potential and existing health plan and other new business payers (e.g., grant funders)
• Act as an essential connection point between the agency and the payer
• Ensure long term payer satisfaction and reference ability

Health Plan Services Marketing

• Collaborate with Agency Communications and Marketing functions to promote and brand-new Healthcare business line.
• Support grant writing and marketing as needed
• Partner with HR and Marketing to manage customer, payer, and employee satisfaction on social media (e.g., Glassdoor, Yelp) that affect customer engagement and staffing for network adequacy

Fiscal Management

• Partner with REDs to monitor budget related to health plan business lines.

Policy

• Collaborate with VP, Policy and VP, Diversity & Equity, for legislative and policy recommendations and/or advocacy.

MINIMUM EDUCATION AND/OR EXPERIENCE:

• Master’s Degree (MA/MS/MPH/MBA) preferred; or equivalent directly related experience
• 5 plus years experience in business development with demonstrated experience in developing and implementing new health plan business strategies and programs.

• 5 plus years experience implementing and working with enterprise applications, EHR and other applications required.

Other Specific Requirements

• Must pass Department of Justice (DOJ), Federal Bureau of Investigations (FBI), and Child Abuse Index Check (CAIC) background clearance.

• Valid California Driver's license with two years of experience driving and clean driving record may be required.

Work Environment/Conditions

Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee may be required to use hands to handle or feel objects, tools or controls; reach with hands and arms; and taste or smell. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

The employee must occasionally lift and/or move up to 25 pounds. In addition, this position requires sitting, standing, walking, kneeling, and climbing.

Uplift Family Services is a behavioral healthcare provider and we are subject to all California Department of Public Health (CDPH) Orders related to healthcare workers including those requiring weekly testing of unvaccinated staff and requiring all healthcare workers be fully vaccinated by September 30th, unless otherwise exempted for Qualifying Medical Reasons.

Employee Statement of Understanding

I have read and understand the job description for my position. I am able to perform all of the essential functions of this position. I agree to successfully complete all required training indicated for this position. I agree to keep all of my required certifications and licenses current and up to date and provide proper documentation of the same to the Human Resources Department. I agree to comply with all Agency policies and procedures. I agree to comply with the agency compliance plan and all laws, rules, regulations, and standards of conduct relating to my position. As an employee, I understand my duty to report any suspected violations of the law or the standards of conduct to my immediate supervisor. As an employee, I will strive to uphold the mission and vision of the organization. All employees are required to adhere to the values in all their interactions with youth and families and fellow employees.