Job Description
Careers With Purpose
Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
Facility: Cherapa Place Building
Location: Sioux Falls, SD
Address: 300 N Cherapa Pl, Sioux Falls, SD 57103, USA
Shift: 8 Hours - Day Shifts
Job Schedule: Full time
Weekly Hours: 40.00
Job Summary
The Chief Operating & Experience Officer, Health Plan is a critical executive-level role within the Sanford Health Plan (SHP) with operational responsibility and financial accountability for $1B in premium revenue. This role has executive responsibility for core health plan operations including call center, claims, billing and enrollment and government programs. Overall responsibility for health plan core operations. This includes claims, billing and enrollment, customer service, and provider relations. Has operational oversight for regulatory and risk functions, including government programs operations and risk adjustment functions. Further, oversees member and employee experience strategies, setting the vision and goals for the culture and experience at the health plan and creating a differentiated experience for members that establishes consumer loyalty and enables growth. Serves as a member of SHP executive leadership team, interacting with Health Plan CEO and the Health Plan Board.
Responsible for operational excellence with accountability across all health plan operations. This includes oversight for: Overall operational process improvement including continuous process improvement, quality assurance, operations training, product implementation, performance measurement, project prioritization and operational capacity planning. Organizational efforts to ensure company processes are compliant and aligned with regulatory requirements across multiple states. Drives quality activities and initiatives, ensuring operational systems and processes are delivering in accordance with products sold, contractual commitments, performance guarantees, and business policies. Responsible for growing provider relations, including maintaining current provider relationships with key provider groups and continuous development of network strategy. Oversees the operational and financial performance of agreements and network adequacy/performance results, optimizing the contracting process to achieve intended outcomes. Ensure cost effective, client-responsive programs are developed and maintained, identify improvement opportunities and oversee successful implementation of those changes throughout shared services. Identify operational efficiencies, meet regulatory requirements and client expectations and develop a 'best practice' for operations. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance and contractual agreements. Assess organizational strengths and weaknesses to drive a high-performing operating model. Lead the transformation of health plan operations (people, process, technology) to create a high-performing and competitive health plan.
Qualifications
Master s degree required or past ten years experience commensurate with area of responsibility.
A demonstrated record of significant career progression, culminating in a senior management position required. A minimum of 5 years of health care or health plan management experience and experience in an executive role preferred.
Benefits
Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit .
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .
Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Req Number: R-0185963
Job Function: Leadership
Featured: No
Job Tags
Full time, Part time, Work from home, Shift work, Day shift,
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