Provider Operations Manager

Summary

Join Gainwell, a cutting-edge product company dedicated to meeting the healthcare needs of our communities. As a Manager, you will be critical in delivering exceptional service and achieving account goals and outcomes. You will oversee and guide your team, manage performance and engagement, optimize processes, and maintain the highest quality standards. Your work directly supports our mission, the Account Delivery Manager [ADM], the Regional Leader, and internal business partners in achieving or exceeding contractual obligations and company goals and objectives.

This role is part of a new contract with a two-year DDI before heading into Operations. Therefore, we are looking for the right candidate who can support both phases of the contract.

Your role in our mission

Your Role in the DDI & Certification Phase

• Oversee the development of the Provider Management (PM) solution with Gainwell business partners, including planning, execution, and delivery of project milestones.
• Participate in the Change Advisory Board (CAB) with the client and other stakeholders.
• Serve as a secondary point of contact for the PM contract during this phase.
• Provide regular project updates, including performance and status reports, and manage corrective action processes (as needed).

Your Role During the Operations Phase

• Serve as the primary point of contact for the PM Services contract and related plans.
• Handle contract administration and coordination of basic contractual/invoicing requirements.
• Engage in formal communication and correspondence with the Agency and serve as the point of contact for Public-facing PM services.
• Oversee the development and monitoring of tools, processes, and procedures.
• Collaborate with MES Module Contractors to provide seamless customer service for all Provider Management inquiries.
• Partner with Gainwell business partners to resolve defects.
• Build, develop, and lead teams of leaders and individual contributors, supporting employees and executing day-to-day operations delivery to meet client service level agreements and driving accountability and efficiency.  
• Establish and effectively lead routines, including utilizing tools and reporting, to drive team performance; train and provide ongoing coaching to ensure employee engagement while maintaining client satisfaction.
• Cultivate relationships with account leaders and business partners to proactively identify and implement opportunities to enhance the delivery of operational products, services, and capabilities.
• Remove obstacles and champion change to create conditions for success, drive employee awareness, and connect employees to their work and contributions.
• Identify and manage existing and emerging risks from business activities and implement mitigation strategies to improve performance.

What we're looking for

• 7+ years of people management experience.
• 5+ years of experience managing implementation and operations of Provider or Major Health Care Payer projects.
• 3+ years of experience managing multi-vendor projects or similar complex integration efforts.
• 2+ years of experience with Outcomes Based Certification, Streamlined Modular Certification, or other Certification efforts.
• Working knowledge of Medicaid Transformation Initiative, Medicaid Information Technology Architecture (MITA) 3.0, and the CMS Conditions for Enhanced Funding.
• Proficiency with Microsoft Office suite and hardware and software applications to manage contact center and back-office operations (Cxone, Verint, Avaya, etc.).
• Strong written and oral communication and interpersonal skills to work effectively with team members, customers, and clients.
• Demonstrated strategic initiative implementation and execution, specifically with operating policies and procedures and work process improvements in customer contact operations.

What you should expect in this role

• The position can be onsite in the Montgomery, AL office or remote, with frequent trips to the area to meet with the client, other vendors, team members, and Gainwell business partners. Anticipate an average of 50% travel, with more being expected during two-year start-up and go-live with less during regular operations.