Sr Operations Manager - TMIPA
Description
Overview:
This leader collaborates closely with clinical and administrative stakeholders, the MSO, and
external partners to implement best practices, streamline operations, and support the transition to
value-based care models. The Sr, Manager ensures programs maintain compliance with
contractual and regulatory requirements while aligning with organizational goals.
external partners to implement best practices, streamline operations, and support the transition to
value-based care models. The Sr, Manager ensures programs maintain compliance with
contractual and regulatory requirements while aligning with organizational goals.
Key Responsibilities:
- Oversee day-to-day operational management of IPA and ACO programs within the TM network.
- Collaborate in developing and implementing effective workflows and interventions that enhance performance in various areas in operations.
- Serve as a liaison between internal teams, MSO functions, provider groups, and health plans to ensure effective program delivery and communication.
- Monitor key performance indicators (KPIs) and program metrics; identify gaps and lead corrective action plans.
- Collaborate closely with Utilization Management, Case Management, Quality, Provider Relations, and Member Services to align operations with strategic priorities.
- Ensure compliance with CMS, DMHC, DHCS, NCQA, and health plan regulations relevant to ACO and delegated managed care programs.
- Support audit preparation, reporting, and documentation to ensure readiness and accuracy.
- Lead analytics and Business Intelligence teams to leverage data insights for operational improvements.
- Work with executive leadership on long-term planning, regional integration, and growth opportunities.
- Manage cross-functional project teams to implement new programs, pilots, and process improvements.
- Provide regular updates, reports, and recommendations to executive leadership.
Qualifications:
Required:
- Bachelor's degree in healthcare administration, Public Health, Nursing, or related field.
- Seven or more years of progressive leadership experience in managed care, value-based care, or population health programs.
- In-depth knowledge of IPA and ACO models, delegated risk, and managed care operations.
- Proven ability to collaborate with physicians, MSOs, payers, and regulatory agencies.
- Excellent organizational, communication, and interpersonal skills.
- Demonstrated success in leading teams and managing complex programs.
Preferred:
- Master’s degree (MPH, MHA, MBA, or related field).
- Experience with Cerner, EPIC, Power BI, Tableau, or similar analytics tools.
- Familiarity with CMS and CMMI initiatives, CMS MSSP, Commercial ACO, Commercial HMO and Medicare Advantage programs.
Work Environment & Physical Demands:
- Regular on-site presence in Torrance with occasional travel to affiliated sites.
- Occasional evening or weekend hours as needed