Open to working from any major Coventry location with a strong preference for our East Coast locations
GENERAL SUMMARY
This position is responsible for applying and implementing the Coordinated Care Plan (CCP) and Prescription Drug Plan (PDP) validation functions. Will develop and manage the validation of performance metrics of known risk areas or identified performance issues to ensure compliance with regulations. The Director, Operations Monitoring is expected to communicate findings and possible solutions to appropriate business units. In addition, the position will monitor end-to-end change management initiatives resulting from CMS regulatory guidance and/or business needs.
ESSENTIAL RESPONSIBILITIES
· Lead a team of auditors and analysts who perform detailed assessment/validation activities of internal business units and external partners to ensure compliance with CMS regulatory guidance as well as Coventry requirements.
Qualifications:· In conjunction with Operations Compliance, coordinate assessment of operational areas as well as first tier, downstream and related entities (FDRs) with special focus on identified non-compliance, high risk areas, and vulnerabilities.
· Communicate business and compliance risks, providing recommended solutions as required, while serving as a point of escalation in instances where resolution has been ineffective.
· Utilize defined protocols and tools established for validating and evaluating performance objectives. Determine appropriateness and feasibility of internal controls.
· Monitor and validate the implementation of changes based on CMS regulatory updates and business process improvements. Ensure process control and improvement initiatives are in place for Parts C/D Operations.
· Communicate findings to the VP, Operations Monitoring; VP, Operations Compliance and appropriate committees and business units.
· Identify and maximize opportunities to use information and technology to improve service levels and/or business processes.
· Understand business processes, systems, tools, regulations and structure and how they interrelate to provide products and services that create value for Coventry customers,
consumers and key stakeholders.
· Adhere to the department budget. Control expenses while meeting SG&A budget demands.
· Identify, select, and retain diverse talent, capitalizing on competencies, ideas and passion. This position will be responsible for aligning talent with key components of the business strategy, creating value for all stakeholders; and assessing, developing and rewarding talent, encouraging progression throughout the organization
· Performs other duties as required
Job Specification Summary – This position requires an intimate knowledge and ongoing validation/assessment of the CMS Part C and D regulations, strong track record of leading complex operations or oversight of such where quality & accuracy requirements are exceptionally high, maintenance of a complex infrastructure that drives highly accurate transactions, required communications, reporting, financial drivers, performance and compliance metrics.
· Significant regulatory experience required with a minimum of 10 years solid operations background, a track record of building high performance teams and ability to work collaboratively in a team-oriented, and matrixed organization experience in government programs division
· Previous (5-7 years) management experience required.
· In-depth experience with regulated lines of business and of managed care policy and direction.
· Strong communication and negotiation skills.
· Ability to perform analysis and legal research to identify and clarify issues
· Excellent team player and leadership skills.
· Excellent interpersonal skills and effective communication and presentation skills.
· Able to effectively coordinate multiple projects.
· Proficient with PC applications.
· Problem solver
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: King of Prussia, PA, US
Other Locations: Bethesda-Maryland-United States,
Organization: 37200 - Coventry Product Services, Inc
Schedule: Full-time
Job Posting: 2013-02-11 00:00:00.0
Job ID: 1212020