Director of Part C Operations

Job Summary

A company is looking for a Director, Part C & Authorizations.

Key Responsibilities

• Set vision and governance framework for Part C authorizations, claims processing, and encounter data operations
• Oversee daily adjudication operations to ensure compliance and quality output
• Establish and maintain performance management frameworks, including KPIs and audit outcomes

Required Qualifications

• 8+ years of experience in health insurance operations with team leadership experience
• Expertise in claims processing and utilization management
• Background in capitated health plan financials; PACE experience preferred
• Bachelor's degree in healthcare, finance, or related field required; Master's degree preferred
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)