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 Services Operations
McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Director, Health Services Operations, to join in leading the organization forward.
MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).
MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, 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.
Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org
Position Summary:
Provides overall management and direction for the McLaren Health Plan (MHP) Health Services and Medical Management activities to meet organizational goals. Assumes oversight and responsibility of utilization review and case management operations. Integrates medical management processes across all relevant departments within MHP with a focus on ongoing communication. Ensures Medical Management processes to be appropriate; compliant with NCQA standards and regulatory agencies and within budget. Develops and implements departmental policies and procedures, as well as documentation of the case management and utilization management processes. Responsible for collaborating in the delivery of the Quality Improvement Performance Plan (QPIP) to facilitate that quality standards are met, with a focus on all assigned NCQA standards. Responsible for the selection, training, development, and implementation of policies and procedures pertaining to the delivery of medical care in a cost efficient and quality-based manner. Leads process improvement initiatives to streamline department workflows and enhance the delivery of care through best practices and data-driven approaches. Responsible for implementing programs and solutions to support MHP’s strategic objectives and improve member-experience and clinical outcomes.
This is a hybrid position with requirements to come onsite as scheduled, Flint, MI.
Qualifications:
Required:
Bachelor’s degree in business, healthcare or another business-related field.
Five (5) years’ experience in a progressively more responsible leadership role in managed care, leading utilization, case and/or quality management with demonstrated experience involving clinical utilization and quality analysis with direct interaction with health care providers, with at least three (3) years’ experience in a management role with direct reports, leading or assisting in all phases of effective supervision (i.e., recruitment, performance management, training).
Five (5) years’ experience managing clinical workflows and care delivery models.
May require weekend supervision of staff.
Preferred:
Professional certification in a related area (i.e., case management, HEDIS).
Ten (10) years’ experience and knowledge of managed care functions (i.e., medical delivery, regulatory compliance, HEDIS, NCQA).
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.
