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
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.
