Director, Health Plan Im Services
Irving , Texas
Provide strategic IT roadmap planning to create tactical plans for execution to optimize the Health Plans IT infrastructure and operational effectiveness for the suite of applications, support operations, and technologies required to create tactical plans for execution to optimize and support the Health Plans operational effectiveness. Advisor/partner to health plan executive leadership for technology business process management (BPM), benefits administration, claims processing, capture and imaging, authorizations & UM, capitation, workflow management, and billing across all LOBS (Tricare US Family Health Plan, New Mexico Medicare, New Mexico Health Insurance Exchange, Texas Health Insurance Exchange, Texas Medicaid).Advises on options, risks, costs versus benefits, and impacts on end-user products and services, business processes and system priorities and leads stakeholder (internal and external) business planning and strategy meetings.Directs the integration of vendors for pharmacy, coordination of benefits (COB), vision and behavioral health. Represents the health plan as IT contact for government agencies (DoD, CMS, HHSC, TDI) and ensure compliance with applicable laws/regulations/requirements Works with health plan and IT executive leadership to appropriate solutions required to support the health plan’s short-term and long-term business goals/strategy and align with IT strategyDrives/leads the health plan data integration effort in support of the population health management program and ACOS. Key member of Medicare Shared Savings Program (MSSP) steering committee regarding data acquisition and governance. Leads diverse team of 12 direct reports with diverse skills sets ( interface engineers, data analysts, project managers , business analysts)