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UC OFFICE OF THE PRESIDENT
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UC Health's self-funded health plans play a significant role in helping the University retain funds spent on health insurance premiums by both the employer (UC) and employees within its own system. In 2014, the University of California launched UC Care, a self- insured PPO health plan. In 2015, UC Care spent only 7% of each premium dollar on administration compared with 15%-20% spent by commercial health plans. This plan provides medical and pharmacy benefits to UC employees, non- Medicare retirees and their families. UC Health is responsible for the administration of the plan. Beginning in January 2017, UC Health is responsible for two high deductible and three additional Medicare plans that are self-insured for employees. Total membership in all these plans is about 85,000. There is also a flex-funded HMO plan, UC Blue & Gold HMO, with an enrollment of 123,000 that has an ACO relationship with the UC medical centers. UC Health provides financial management, population health management and strategic thinking to the medical centers for this plan, in addition to co-administering the plan.
The Senior Director of Self-Funded Plans reports to the Executive Director of Self- Funded Health Plans in UC Health at UC Office of the President (UCOP). Using a high degree of knowledge in the overall field, the position works collaboratively as part of a dynamic team, offering expertise, problem- solving, and strategy solutions. The Senior Director is responsible for the operations (administration, communication and financial) of the UC Blue & Gold HMO and one or more of the PPO plans. This position is expected to determine objectives, direct programs, develop strategies and policies, manage human, financial, and physical resources and function with a high degree of autonomy. Under the direction of the Executive Director, the Senior Director will actively assess risks and establish systems and procedures to protect organizational assets. Continual evaluation of the plans is a critical factor for success. Decisions made by this position require consideration of a variety of factors, including an understanding of current business trends.
The position supervises a Program Manager who has responsibilities for the daily administrative management and vendor relations of the self- funded health insurance plans, which provide benefits to UC employee, non-Medicare retirees, graduate students and their families. The Senior Director has responsibility to achieve broad goals by establishing objectives, direct programs, develops strategies and policies, and manages human, financial and physical resources. The incumbent is expected to establish work plans and delegate assignments to subordinate managers. Reviews and approves recommendations for functional programs. Involved in developing, modifying and executing policies that affect immediate operations and have organization-wide effect. This position manages cross-functional and cross-organizational teams to develop and implement programs while ensuring quality deliverables and outcomes. Problems/issues addressed are of a diverse scope where management of issues or data requires in-depth evaluation of variable factors. The position requires collaboration with a diverse group of colleagues and business partners in a complex organizational structure.
Oversee the activities of the University's third party claim administrators (TPA) and other vendor partners for self-funded plans to ensure a high quality of claims administration; In collaboration with UC Health leadership, create and maintain a benefit structure that provides affordable, comprehensive coverage to UC employees and their dependents; assist leadership and Executive Director with strategic direction and growth of the self-funded health plan program.
Leads regular status meetings with vendor partners, including consultant/ brokers, to ensure all ongoing issues and deliverables are handled and all staff meet expectations of their job functions; Oversee self-funded plan operational implementations as necessary; work with Office of General Counsel to ensure contracts are executed and implemented according to University policy. Lead and participate in the development of a cross functional program operations manual.
Working with Executive Director of Self-Funded Health Plans, coordinates management of external consultants to provide actuarial analysis and administrative guidance to the plan, and ensure consistency with higher education benchmarks and insurance industry standards as appropriate
Assign and supervise activities of self-funded health plan staff to ensure high levels of productivity and accuracy; address staffing needs to ensure continuity of service levels.
Collaborates on the development and execution of the marketing strategy and communications of the self-funded plans; Provide support activities relating to the population health group.
In collaboration with leadership and Procurement, conduct RFPs for potential vendors, contract with health insurance carriers and administrators, and uphold contract terms over the life of the agreement. Administer vendor performance agreements and coordinate annual renewals.
Requires a minimum eight years' experience managing the implementation and administration of health benefit programs, preferably self-funded plans. institution desired.
Requires direct healthcare operations management expertise in self-funded healthcare products, benefits, eligibility, enrollment, enrollment systems, call centers, Electronic Data Interface (EDI), premium billing, program/systems/product implementations and HIPAA.
Solid experience implementing large-scale/ complex/political change initiatives with demonstrated leadership in business planning, financial planning and analysis and program development required. Proven experience engaging and working in a team environment required. Proven experience in project management, development and facilitation of planning sessions with executives, physicians, directors/trustees, management and consultants desired. Ability to gain cooperation and support through effective use of influence and persuasion required; tact and diplomacy required. Demonstrated customer service focus in all decisions and actions required.
Ability to work with minimal supervision; self-directed and detail-oriented. Requires the ability to effectively oversee multiple projects simultaneously as well as manage large and diverse teams to deliver results within specified time frames. Ability to supervise and motivate staff and team members to achieve unit and program objectives.
Proven knowledge of principles and procedures of fully-insured and self-insured/self-funded health plan administration, current literature, trends, and developments in the field of benefit program administration, principles and practices required to develop, implement, and evaluate health and welfare benefit programs, legal regulations applicable to employee health insurance programs (HIPAA, PPACA, CMS, etc.), university policies, procedures, practices, objectives and structure applicable to employee benefits.
Proven ability to use original thinking and independent judgment to develop solutions reflecting the legal, policy, and operational needs of the organization; Possesses effective operational thinking and expertise with the ability to analyze and understand healthcare operations quickly to become a trusted advisor or demonstrate in depth knowledge of healthcare operations based on past experience.
Proven ability to maintain an organized approach, clarity of purpose, and goal orientation in a rapidly changing environment involving multiple stakeholders of various levels from throughout the organization. Strong action planning skills and ability to manage multiple priorities and deadlines.
Excellent organizational skills with demonstrated ability to manage multiple projects and meet deadlines. Ability to lead and pursue objectives independently while exercising good judgment and exhibiting a considerable degree of creativity.
Proven ability to establish and maintain trust, confidence, and effective working relationships with colleagues and individuals of diverse occupational and social backgrounds. Strong political acumen to intricate situations occurring in a complex, decentralized organizational structure; guide and negotiate complex issues through a hierarchical, bureaucratic organization to achieve resolution.
Proven experience working in a rapidly changing environment; must be able to handle pressure and react positively to stressful situations.
Advanced knowledge of Windows and the Microsoft Office Suite including word-processing, spreadsheet applications, project management and database programs. Excellent time management and organizational skills.
Excellent ability to quickly evaluate complex issues and identify multiple options for resolution.
Demonstrated experience working collaboratively and influencing across a matrix environment.
Experience working directly in or with health care institutions strongly preferred.
Bachelor's degree in a health related field, or any combination of relevant education and experience which would demonstrate knowledge, skill, and ability to perform the essential duties and responsibilities.
SALARY AND BENEFITS
Salary: Salary commensurate with experience.
Benefits: For information on the comprehensive benefits package offered by the University visit: Benefits of Belonging
HOW TO APPLY
Please be prepared to attach a cover letter and resume with your application.
APPLICATION REVIEW DATE
The first review date for this job is November 25, 2020. The position will be open until filled.
Smoke Free Work Environment: The University of California, Office of the President, is smoke & tobacco-free as of January 1, 2014. UC Smoke & Tobacco Free Policy
The University of California, Office of the President, is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status. EEO/AA Employer UC Nondiscrimination Policy
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About University of California Office of the President
The Office of the President is the systemwide headquarters of the University of California, managing its fiscal and business operations and supporting the academic and research missions across its campuses, labs and medical centers.