Director Health Plan Operations

Providence Health & Services
life insurance, parental leave, 401(k)
United States, Washington, Renton
Jul 15, 2025
Description Calling All Visionary Operations Leaders! Are you ready to drive strategic excellence and operational innovation in healthcare services? Do you thrive on navigating complex challenges and shaping the future of healthcare operations? If so, we have the perfect opportunity for you! The Role: As the Director of Operations for USFHP at Pacific Medical Centers, you will provide leadership for member services, enrollment, benefits and systems management, and the clinical quality management program. In collaboration with the Executive Director, you will develop and implement policies, procedures, and training materials, ensuring compliance with Department of Defense contract and policy requirements. Your role includes oversight of budget monitoring and member satisfaction, with programs to enhance results. You will serve as the principal PMC representative on the national USFHP Alliance Operations Committee, driving regular reporting and data analysis to support division functions and reporting to the Quality and Patient Safety Committee. What You'll Do: Operational Excellence Leader: Manage departments responsible for services under the USFHP contract, ensuring compliance with Department of Defense policies and regulations. Budget and Performance Manager: Develop departmental budgets, maintain performance tracking systems, and ensure adherence to financial targets. Integrity and Appeals Manager: Oversee the integrity program and appeals process, evaluate staff presentations, and make decisions on post-service, network, and benefit appeals. Customer Satisfaction Advocate: Actively solicit customer feedback, resolve complaints, and ensure service excellence and teamwork within departments. Training and Development Champion: Manage staff orientation, training, and ongoing performance feedback, participating in ongoing staff development programs. What You'll Bring: Educational Background: Bachelor's Degree in Health Care Administration or Business Administration preferred. Experience: 4+ years of healthcare business office or member services experience with progressive responsibilities, and 3+ years in a managerial role within managed care settings. Managed Care Expertise: Proven expertise in managed care insurance, patient accounting activities, referral, and claims processing. Leadership and Critical Thinking: Skilled in inspiring staff, evaluating situations contextually, and practicing sound judgment. Communication Skills: Ability to interact professionally, maintain confidentiality, and communicate effectively in both verbal and written formats. Why Join Us? Make a Real Difference: Be part of an organization transforming healthcare operations and improving patient experiences. Unleash Your Potential: Enjoy autonomy and support to bring innovative ideas to life. Work with the Best: Collaborate with a team of talented professionals passionate about their work. Thrive in a Dynamic Environment: Embrace the challenges and rewards of working in a fast-paced, evolving industry. Ready to Shape the Future of Healthcare Operations? If you're a visionary leader with a passion for advancing healthcare operations, we encourage you to apply! Join our team and help us create a healthier future for all. 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. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Requsition ID: 373772 Company: Pacific Medical Jobs Job Category: Member Services Enrollment & Billing Job Function: Health Plans Services Job Schedule: Full time Job Shift: Day Career Track: Leadership Department: 3060 WA USFHP Address: WA Renton 620 Naches Ave SW Work Location: Blackriver Corporate Park-Renton Workplace Type: Hybrid Pay Range: $74.17 - $117.10 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.