This position provides overall management & direction at the medical center for Member Services staff & oversight responsibility of case processing, & quality of information & services provided by staff to clientele, to minimize the financial liability for the organization, & maximize prudent stewardship of member dues. In addition, it ensures contract integrity for the member & for Kaiser Permanente & educates customers, colleagues, & the community about Kaiser Permanente's services & benefits. This role also builds relationships & collaborates w/ a variety of internal & external clients to develop strategies, action plans, & member-focused systems to support business objectives & the joint vision of KFH/HP & the medical group.
Essential Functions:
- Hires, supervises, & develops staff who handle sensitive & multi-faceted member issues & requests
- Oversees the daily operations of the member services department, including linkage w/ auditing, training & analyst work to best meet the needs of staff, members, key stakeholders, & leadership
- Orients & educates facility departments, physicians, & other professional staff regarding health plan products, benefits, regulatory guidelines, resolution of member questions, complaints & grievances
- Acts as key liaison w/ the medical group; develops programs & service improvements in conjunction w/ key medical group personnel, managers, & physicians, to improve member experience
- Provides ongoing information, reports, & recommendations to facility departments & physician chiefs related to data analysis & provision of reports & information
- Promotes member satisfaction & retention & influences key decision-makers via use of appropriate service strategies & techniques
- Negotiates & works collaboratively w/ facility staff & applicable regional departments to reach satisfactory service solutions to issues that optimize member experience w/ service
- Oversees compliance/quality/training staff & their work at the local level
- Maintains a current knowledge base regarding regulations & compliance standards, policies & procedures, contract interpretation, service protocols & facility knowledge
- Works directly w/, & fosters collaborative working practices between local member services & the correspondence center(s), applicable regional departments, & other departments at the medical center
- Ensures that staff provide timely & thorough responses to members, their physicians, authorized representatives regarding the Health Plan's response to complaints & grievances that are handled at the medical center level
- Collaborates effectively w/ units in the Member Services Organization, & Health Plan units to ensure compliance w/ regulatory & accreditation standards
- Provides recommendations on external environment & internal practices to leadership w/ relation to risk mitigation
- Participates in management team committees & task forces related to operations, service & other facility, regional or statewide initiatives
- Manages departmental budget to meet or exceed organizational goals & provide optimal departmental operations
- Participates in regulatory & accreditation agencies' audits & surveys related to the complaint & grievances
- Provides reports required by the Health Plan Regulatory Services (HPRS) department to be reported to regulatory agencies
- Maintains influencing relationship between the medical center & the medical group administration (MGA)
- Reports indirectly to the DHO/COO at the medical center
Qualifications:
Basic Qualifications:
- Five (5) years of management/leadership experience in a complex healthcare (preferably HMO) or service-oriented organization
- Five (5) years of management/leadership experience in health care
- Five (5) years of experience in a complex health care or service organization
- Significant experience in customer service improvement & process redesign, w/ openness to creative & innovative approaches to providing service, including cultural sensitivity, respect & polite communication w/ patients & all clientele
- Significant experience/knowledge working w/ accreditation & regulatory agencies &/or preparing information for regulatory audits as requested, including, but not limited to Dept of Health Services(DHS), Department of Managed Healthcare(DMHC), National Committee for Quality Assurance(NCQA), & Center for Medicare/Medicaid Services(CMS)
- Bachelor's degree or equivalent experience
- Master's degree preferred
- Management & leadership skills, including working w/ varied levels of staff, budgeting, delegation, staff development, coaching, resource allocation planning, & performance management
- Ability in development of team focus, partnership, service orientation, influence & change leadership
- Expertise in results orientation, taking initiative
- Knowledge regarding Health Care regulation & compliance standards, internal policies & procedures
- Outstanding interpersonal/communication skills w/ ability to effectively partner w/ a wide group of stakeholders, including professional & medical staff
- Excellent presentation/public speaking skills & experience
- Awareness in emotional intelligence as modeled in day-to day leadership responsibilities
- Ability to use sound judgment & handle potentially charged issues independently & w/ knowledge & ability to escalate & obtain assistance when needed
- PC Skills/computer literacy (MS Office: Word, Excel, & PowerPoint)
- Excellent investigation, problem solving & documentation skills preferred
- General working knowledge of Kaiser Permanente Health Plan benefit plans/contracts/systems
- Proven ability & commitment to work collaboratively in a Labor Management Partnership
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.