Director, Plan Operations & Administration

Role Overview: The Director of Plan Operations & Administration is responsible for ensuring full compliance with state program contractual and regulatory requirements, including benefit and payment rules, data submission standards, and performance benchmarks. Acting as a key liaison between the state, health plan, and enterprise functions, this role drives operational excellence by ensuring contractual obligations and service levels are maintained across corporate, regional, and local operations.

Work Arrangement:

• Hybrid The associate must be in the office at least 2 to 3 days per week at our Dublin, Ohio (OH) location.

Responsibilities:

• Monitor service levels across all supporting functions and initiate corrective actions as needed.
• Oversee provider contract data submission for accurate system configuration and claims payment.
• Manage internal operations and coordinate corporate functions supporting claims processing and encounter data submissions.
• Maintain current policies and procedures for local functions in compliance with regulatory standards.
• Track state bulletins, assess operational impacts, and coordinate system and process changes.
• Convene regular operational meetings with peers (e.g., provider network management, compliance, community outreach) to ensure alignment.
• Collaborate with the Regional Chief Financial Officer (CFO) and Chief Medical Officer (CMO) on cost containment initiatives, action plans, and performance tracking.
• Identify and mitigate risks impacting strategic and financial objectives.
• Coordinate responses to Ohio Department of Medicaid (ODM) inquiries and prepare for audits and site visits.

Education & Experience:

• Bachelors degree required
• 5 to 10 years of progressive leadership experience in government programs, health plan operations, with a strong focus on Medicare and Medicaid programs.
• Previous management experience in a matrixed organization is required.
• Proven ability to lead teams, inspire collaboration, and translate complex strategies into actionable plans.
• Experience working with state government agencies and fostering strong relationships.
• Background in public health and government programs required.

Skills & Abilities:

• Strategic leadership with the ability to motivate and align teams toward achieving operational and financial goals.
• Strong communication skills to simplify complex strategies and inspire execution.
• Expertise in health plan operations, provider network management, and member engagement.
• Ability to drive efficiency, improve operating margins, and enhance provider satisfaction.