NJM Insurance Group

Director of Operations

NJM Insurance Group

full-time

Posted on:

Origin:  • 🇺🇸 United States

Visit company website
✨ AI Apply
Manual Apply

Salary

💰 $167,700 - $233,310 per year

Job Level

SeniorLead

About the role

  • The role is accountable for the oversight of operations supporting Braven Health. Successfully leads the execution of a portfolio of programs and projects that support Braven Health Medicare Advantage (MA) business. Enables the realization of Braven Health operational, quality, and financial goals. Partners with executive leadership to define, prioritize, plan, execute, and monitor Braven Health business. Accountable for the general oversight of operations supporting Braven Health. Oversees operational and financial performance. Develops and implements strategies to achieve performance and sustainability targets. Supports annual CMS bid submission and go-to-market implementation. Manages and optimizes administrative cost and budgets. Develops presentation material for governance forums. Reports directly to the Chief Executive Officer of Braven Health. Actively participates in the creation and execution of multi-year business plans and operating model. Develop business cases and maintain a project portfolio and roadmap for Braven Health. Identify and prioritize implementation and process improvement programs or projects that markedly move us towards operational excellence, repeatability, and scalability, including projects with a focus on improving member experience and retention. Conduct portfolio reviews with management team and ensure business owners are appropriately engaged and informed. Maintain effective communication with senior leadership (EVPs, SVPs), making them aware of portfolio status, critical risks, and issues. Foster collaboration between operational departments, leadership, and vendors to support improvements in operational and financial performance. Support annual product and go-to-market strategy, bid submission, and benefit implementation. Develop playbooks for a repeatable, consistent, and well-documented approach to industry-standard programs. Develop and maintain dashboards, scorecards, and tools that provide actionable insights into key performance indicator(s) for the Braven Health management team. Review externally facing Braven Health materials for accuracy and consistency. Identify opportunities for enhanced Braven Health education and training across operational teams and collaborate with Training Department to develop material. Use a data-driven approach to identify, escalate, and remediate critical risks and issues proactively. Conduct post-mortem exercises following project completion and monitor action plans to address challenges.

Requirements

  • High School Diploma or GED required. Bachelor degree preferred or relevant experience in lieu of degree. Requires a minimum of 10 years of experience working for a Medicare Advantage plan. Experience in Medicare Claims, Service, Enrollment, Grievances, Appeals, Clinical/Utilization Management, Finance, Stars, and Revenue Optimization preferable. Experience managing budgets. Strongly prefers experience in leading cross-divisional teams on new programs and business development opportunities. Knowledge of project management methodologies, tools, and practices. Requires knowledge of the health insurance industry. Requires knowledge of strategic planning concepts. Experience with Medicare Advantage required. A deep and broad understanding of the MA program and regulations. Requires strong project management skills. Requires creative thinking and problem solving skills. Must be self-motivated. Requires strong leadership skills. Requires strong organizational skills and the ability to manage multiple priorities and deadlines. Requires excellent PC skills and the ability to effectively utilize project management software. Requires proficiency in Microsoft PowerPoint and Excel. Requires excellent oral and written communication skills. Requires excellent conflict resolution and negotiation skills. PMI Certification or completed course work toward PMI Certification preferred but not required