Director of Strategic Health Operations PG 010 $98,480-$147,720
The North Carolina League of Municipalities (NCLM) is initiating the recruitment process for a Director of Strategic Health Operations in the Risk Management Services Department. Responsibilities of this position include to provide direction and oversight to the strategic and operational component of the Municipal Insurance Trust (MIT), providing a solvent, thoughtful and comprehensive approach to ensure member needs are met now and into the future. Providing marketing support for both the health benefits and risk management services. This is accomplished by setting objectives, analyzing data related to performance, understanding the health care industry, recommending solid fundamental business ideas, developing strategic direction to maintain pool sustainability in a challenging health insurance industry and by growing the business. This also includes creation of high quality materials for board of trustee discussions and policy decisions, managing vendor performance, recommending and developing new programs, plan designs, underwriting methodologies and working closely with other League departments. Oversees underwriting, new business, endorsements and renewal process. Other duties include serving on the risk management and League leadership initiatives.
Identifies and analysis business drivers and components to determine performance issues and determine their impact on short and long term business goals. Sets objectives by analyzing data related to performance and develops solid fundamental business objectives for growing the business and adding to the overall health of the program.
Directs health program by; overseeing benefit plans offered; monitoring claims activity and financial status; responding to inquiries and appeals; overseeing Medicare part D reconciliations; coordinating focus group meeting; and serving as HIPAA Privacy Officer.
Manage MIT third party vendors by monitoring performance; scheduling vendor meetings; assuring vendor meets contractual requirements; managing fee arrangements with Consultants; and participating in the negotiation of contract terms.
Cultivates ongoing member relations by presenting at various affiliate member conferences; attending NC City County Managers Association meetings; and addressing issues with health benefits trust.
Assists with development and implementation of MIT strategic initiatives and marketing plan; overseeing preparation of bids, renewal process and development for new business targets; and coordinating marketing strategy meetings.
Assists with strategy, development and implementation of NCLM/RMS marketing plan by assisting with RMS Annual Report preparation; directing planning and organizing of regional meetings; and overseeing NCLM/RMS presence at League conference.
We are looking for an experienced, self-motivated candidate who desires to work for a progressive mission driven organization dedicated to supporting North Carolina local government. If you meet the requirements and are interested in being considered for this position please follow the application process at the link below.
Bachelor's degree or equivalent in business, finance, risk management or related field from an accredited four-year university is required for this position. Master’s Degree preferred.
Advanced business and technical skills in the healthcare, insurance or business industry with a minimum of 7 seven years of successful business leadership serving in both leadership and individual contributor roles. Requires business or health care (industry and payor) knowledge to understand financial principles for evaluating program performance. Prefer strong knowledge of current health insurance regulations and emerging programs to remain competitive, control cost and add to the overall value of the health insurance pool. Ability to understand coverage, underwriting and industry offerings for core products (medical, dental and vision) and ancillary products (life and disability products). Excellent management, organization and leadership skills
Business knowledge to develop strategic direction and maintain pool sustainability in a challenging health insurance industry.
Must demonstrate advanced analytical skills to identify trends and develop solutions to respond to program performance.
The ability understand/quickly learn the MIT business drivers and components well enough to identify performance issues and analyze their impact on short and long term business results.
Prefer Insurance License from the North Carolina Department of Insurance and AHIP Certification, Valid Class C Driver's License.
Interpersonal skills suited to interact with and communicate effectively – in all directions.
Ability to keep, maintain and communicate a broad business perspective – from mission/vision through the operational level.
Ability to solve problems, providing the necessary insight to recognize the problem, the ability to explain and prioritize the importance to all impacted and the ability to take the appropriate measures to resolve. Ability to understand current market trends, best practices and programs.
Ability to understand and work in a network to negotiate and produce measurable results that impact both member satisfaction and benefit spend.
Ability to work in a team of high-functioning, experienced and independent professionals and vendors.
Ability to set objectives by analyzing data related to performance and to develop solid fundamental business decisions for growing the business and adding to the financial health of the program.
Requires strong communication skills.
Previous experience working in the health-care industry with payor experience preferred.
Consensus-building across functional-levels and with external/internal stakeholders
Knowledge of federal, state, and local laws, rules, and regulations pertaining to insurance and self-insurance funds.
Knowledge of municipal government structure, operations and risk exposures.
Skill in interpreting and explaining complex insurance policies and documents.
Requires excellent written and verbal communication skills and ability to direct messages to and interface with multiple audiences, both externally and internally.
Ability to interact at high level of public contact, requiring tact and courtesy.
Interpersonal skills to facilitate work with a wide range of individuals and groups from culturally diverse backgrounds.
Available to travel statewide and occasionally out of state including overnight stays.
Prefer Insurance License from the North Carolina Department of Insurance.
America's Health insurance Plans (AHIP) designation would be beneficial and preferred.
Valid Class C Driver's License.
This role reports to the Associate Executive Director of Risk Management Services. This position is located in Raleigh, NC.
Deadline: October 4 or Until Filled
About NC League of Municipalities
The North Carolina League of Municipalities is a member driven organization representing the interests of cities and towns in the state. Through their collective efforts, League member cities and towns better serve their residents and improve quality of life.
For more than 100 years, the League has been one voice for cities and towns working for a better North Carolina.