About Us
McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan and Indiana. The McLaren system includes 13 hospitals in Michigan, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 53 National Cancer Institute-designated comprehensive cancer centers in the U.S.
Director, Health Plan Operations
We are looking for a Director, MIG Operations, to join us in leading our organization forward.
McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.
McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org.
MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org/.
Position Summary:
Provides overall direction and management in providing superior operational services to McLaren Integrated HMO Group’s health plan subsidiaries (HP). Oversee and directs all operational areas including, but not limited to, membership, claims processing and plan benefits management. Assists where necessary or through project management those business ventures undertaken by the Company to ensure its profitable future.
This is a hybrid position with requirements to come onsite as scheduled Flint, MI or Indianapolis, IN.
Equal Opportunity Employer of Minorities/Females/Disabled/Veterans
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Qualifications:
Required:
- Bachelor’s Degree in business, health care or related field.
- In-depth understanding of claims administration including claim code sets, EDI transactions, pricing methods including APR-DRG, OPPS/APC and fee schedules, and state and federal policy.
Preferred:
- Certification as appropriate to position.
- Five (5) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g. accounting/finance, reinsurance, EDI, marketing, administration, medical delivery, regulatory compliance, claims processing, membership/eligibility, contracting and risk arrangements and actuarial precepts).
- Two (2) years’ experience in claims and enrollment system configuration and maintenance.
- Two (2) years’ experience in payment integrity, claims editing and recovery operations.
- Affiliation with a Professional Organization.
Equal Opportunity Employer
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
