Lombard, Illinois Employment Opportunities

Operations Director/Deputy Project Manager

HealthSystems of Illinois works under contract with the Illinois Department of Healthcare and Family Services (HFS) to provide Medicaid certification for admission, concurrent and continued stay, as well as retrospective prepayment and post-payment review for inpatient care in a combination of medical/surgical and psychiatric facilities. At HSI we are dedicated to continuous quality improvement. It is our corporate goal, and our goal for each employee, to deliver the most responsive and effective service possible to the Illinois Department of Healthcare and Family Services, as well to Medicaid participants and providers of Illinois. We are looking for an Operations Director/Deputy Project Manager who will ensure that all utilization and quality review operations are run consistently and meet our client requirements. In addition the candidate will have the following qualifications:

Credentials and Experience:

• Health care professional with active, unrestricted licensure or certification applicable to the educational background and area of practice
• Utilization review experience: Minimum five years
• Prior management experience: Minimum one year at a level equivalent to an Assistant Director or five years at a level equivalent to a Manager
• Call center management experience
• Prior fiscal management responsibility including budget development and administration
• Preferred

• Minimum: Bachelors Degree

• Experience working with Medicaid and/or Medicare services or programs

• Health care quality improvement or quality management experience

• Experience developing or leading case management and/or disease management programs

• Process and/or system design experience

• Broad based clinical experience

• Account or client management experience

• Project management experience

• Knowledge of URAC or NCQA utilization review accreditation standards  

Additional Traits or Skills:

• Strong leadership and personnel management skills
• Demonstrated history of making sound and reliable decisions independently
• Strong analytical skills including reliability in formulating relevant conclusions and recommendations based on findings from independently conducted data analyses
• Effectiveness in readily translating concepts into actionable business requirements and practices 
• Exceptional business writing skills
• Strong presentation skills
• Effectiveness in establishing strong client and customer relationships
• Proficient with Microsoft Word and Excel. Experience with Power Point

 Major Responsibilities:

• Ensures that all utilization and quality review operations consistently comply with all client requirements.
• Ensures that policies and business practices are consistently relevant, reliable and administered cost-effectively.
• Provides direct supervision of designated management personnel and/or of various non-clinical, program or contract support staff, and indirectly supervises a variety of clinical and non-clinical positions and personnel.
• Formulates and develops program improvement as well as client and customer relations strategy and tactic recommendations.
• Serves as a principal point of contact and operations expert for the client and for Medicaid healthcare inpatient care providers
• Prepares and analyzes financial and other management and client reports, (as indicated based on findings) identifies performance improvement opportunities, and oversees implementation and ongoing administration of approved plans.
• As needed, delivers presentations to the client and other external customers.
• As requested, actively contributes to corporate business growth or expansion through participation in such areas as identifying new business opportunities and authoring responses for RFPs.

Must be willing to travel occasionally, including periodic overnight travel (< 10%). Qualified applicants should submit a resume with their salary requirements to:

 HealthSystems of Illinois is an Equal Opportunity Employer