Director - Integration Member Services - Bishop & Company - Honolulu

Job description
Bishop & Co. is seeking qualified candidates for a Director of Integration Member Services position for their client, a national company in Honolulu.

Director of Integration Member Services ( #13009)
Summary
The Director of Member Services is accountable for ensuring adherence to the Member Services Program requirements as defined by the State of Hawaii, Department of Human Services (DHS), Med-QUEST Division and oversight of the end-to-end Member experience across our clinical and non-clinical venues. Oversees the operational performance, strategy and member, customer, partner engagement for Hawaii's Member Services Call Center, Appeals, Grievances and Membership Administration functions as they relate to our members as well as the provider services Call Center.

What will I be doing?
In this position, you would represent Hawaii on associated National Communities of Practice and own relationships with related National Shared Service operations to speak on behalf of our program.

You would be responsible for driving process improvements in consumer engagement and experience across all touch points and functions while continuously focusing on improvements in operational practices inside of Hawaii, across Shared Service operations and internal/external communication.



You would communicate goals, objectives, accountabilities, priorities, and authority parameters to your assigned staff.

Essential Functions

• Provides ongoing leadership and direction in the continuous improvement of Hawaii's Integration administrative platforms.
• Identifies opportunities to improve the efficiency/effectiveness of our Health Plan functions, collaborating between Regional area and the National Shared Service functions, and customer service groups.
Creates and implements strategy to maximize consumer engagement, communication and the overall customer experience based on feedback from parties inside and outside of immediate functional ownership. Develops and monitors operational and consumer satisfaction metrics in the assessment of existing performance and opportunities for improvement. Monitors performance against contractual requirements.
Ensures compliance with all State and Federal regulations and promotes compliance among team members. Ensures functional performance above Regulatory, National and Regional targets.
Develops and implements departmental policies and procedures for customer service, membership administration, and oversees the grievance and appeals process.

Desired Skills and Experience
Qualifications

• Minimum nine (9) years of experience in business function management in a health care setting, health care administration, medical administration OR equivalent related experience managing large, complex service operations functions in a Health industry related setting.
• Minimum three (3) years of management experience.
• Demonstrated experience and skill in strategic planning in a multi-faceted health care or service industry system, leadership, collaborator ability to determine the key business issues and to develop appropriate action plans from multi-disciplinary perspectives, ability to envision, create and implement new program design, project management plans and strategic plans.
• Demonstrated experience and skill in working with senior level managers. Knowledge of the fundamentals and dynamics of business process re-design.
• Demonstrated experience and skill in communication, facilitation, presenting, planning, organizing, problem solving, analysis and attention to detail.

Preferred Qualifications:
• Experience in the management and operations of Medicaid business lines - Hawaii experience preferred
• Call Center management and/or appeals experience.
• Strategic planning experience in a managed care organization.
• Knowledge of health plan benefits, contracts and services.
• Knowledge of clinical level activities.

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