Overview
**Description**
**THE ROLE**
Reporting to the Chief Financial Officer (CFO), the executive director is responsible for strategic planning, directing, and evaluating the operations of the US Family Health Plan (USFHP). This position is responsible for budget development, revenue growth targets, network development within current DoD approved zip codes and expansion zip code areas, and other goals established by the PacMed Community Board and CFO for the USFHP including government relationships at a strategic and policy level. Serves on the national USFHP Alliance Board of Directors as the principle PacMed representative. This position ensures the effective operations of all health plan processes (as directed by the Department of Defense) including but not limited to: enrollment, claims processing, customer service, marketing, URAC accreditation, DoD annual audit, credentialing and network performance.
ESSENTIAL FUNCTIONS
+ Participate (in conjunction with Board and the CFO in long range planning to achieve strategic goals of the USFHP.
+ Responsible for developing, recommending and implementing policies for effective delivery of health care services in conjunction with the Medical Leadership and the health plan for all network facilities.
+ Represent USFHP and maintain relationships with the USFHP Alliance Board, Government Relations team and Congressional Delegates as well as state work in the local health care community.
+ Ensure that CFO and Community Board are fully briefed on operational and health plan issues.
+ Responsible for identifying and executing provider contracts aligned with regional growth strategies.
+ Responsible for the contract strategy development in concert with changing requirements of Defense Health Agency (DHA), contract negotiations, and contract compliance.
+ Responsible for managing the entire department responsible for the provision of services under the USFHP contract with the Department of Defense.
+ Responsible for assuring the USFHP Compliance and Privacy Program meets DHA and DoD contractual and URAC requirements.
+ Responsible for growth within currently approved zip codes and expansion to new zip code areas as delineated in the strategic plan.
+ Responsible for delegating and providing oversight of the USFHP Credentialing Program to be sure it meets DHA and DoD contractual and Utilization Review Accreditation Commission (URAC) requirements.
+ Develops the departmental budget and is responsible for adherence to budget, including maintaining records and systems to track performance.
+ Responsible for assuring compliance with Department of Defense policies and contract regulations. Acts as the principle contact for security issues with the federal government.
+ Responsible for delegating and providing oversight to the appeals process for claims and referrals.
+ Manages the appeals process, including ongoing evaluation of the staff who research and prepare appeals for presentation. Decision maker for all post service, network and benefit appeals. Acts as second level manager for grievances. Works with patient and or vendor to reach resolution.
+ Maintains monthly reports that give clear, measurable information to the executive team and Quality Committee.
+ Actively solicits customer feedback on performance of assigned departments; resolves customer complaints, refers unresolved complaints onto the Vice President as needed.
+ Manages the orientation and training and ongoing performance feedback of staff; complete yearly performance appraisals on each employee and interim updates as needed/required.
+ Participates in the planning of ongoing staff development programs focused on improving the quality of the services delivered in the department.
+ Responsible for operations, case management, utilization management, claims management and patient satisfaction.
+ Demonstrates “service excellence” and a commitment to team participation in departmental decision-making.
**QUALIFICATIONS**
+ Bachelor’s Degree in Health Care Administration or Business Administration (preferred)
+ 10 or more years in a progressive leadership role within Pacific Medical Centers or commercial health plan
+ Proven expertise in managed care insurance, patient accounting activities for professional billing, referral and claims processing network and benefits
+ Comprehensive understanding of managed care principles, indemnity insurers, and government insured
+ Skilled at critical thinking
+ Demonstrated skills at inspiring staff to give their best selves to their work
+ Demonstrated skill at evaluating situations with the context in mind
+ Adaptable and demonstrates openness to change and to new ideas
+ Practices sound judgment
+ Ability to interact in a professional manner, and maintain patient confidentiality
+ Demonstrate ability to communicate well (in both verbal and written formats) with patients, staff, and providers.
**About Providence**
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
**About the Team**
Pacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network with outpatient clinics and primary and specialty care providers in King, Snohomish and Pierce counties. We combine decades of patient-centered care with cutting-edge technology, first-class facilities and board-certified providers.
Our strong team environment and respect for our people—at all levels and from all backgrounds—allow us to provide authentic care that achieves the highest-quality patient outcomes, backed by the strong network of resources and support through our affiliation with the Providence family, including local partners like Swedish Health Services.
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
**Requsition ID:** 247797
**Company:** Pacific Medical Jobs
**Job Category:** General Operations
**Job Function:** Operations
**Job Schedule:** Full time
**Job Shift:** Day
**Career Track:** Leadership
**Department:** 3060 WA USFHP
**Address:** WA Seattle 1226 S Judkins St
**Work Location:** PACMED Q5-Seattle
**Pay Range:** $78.89 – $141.03
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
