Mgr Business Systems- TRICARE

Health Net, Inc. (NYSE: HNT) is among the nation’s largest publicly traded managed health care companies. Health Net’s mission is to help people be healthy, secure and comfortable. The company’s POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals. For more information on Health Net, Inc., please visit the company’s Web site at www.healthnet.com.


 


Health Net Federal Services, Inc. is the Government Operations Division of Health Net, Inc. As the first company in the United States to develop comprehensive managed care programs for military families, Health Net has a long history of providing cost-effective, quality managed health care programs for government agencies. Under the TRICARE North contract, we provide health care services to 2.7 million uniformed services beneficiaries. The North Region includes: Connecticut, Delaware, the District of Columbia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia, and Wisconsin. In addition, the contract covers a small portion of Tennessee, Missouri and Iowa.


 


 


ESSENTIAL DUTIES AND RESPONSIBILITIES:





Manage a team of Operations analysts in the support of Enrollment business systems.  This includes design and development of  business systems requirements, system testing, triage and investigation of reported system issues, development of reports and system documentation, and management of all projects related to system upgrades and enhancements. Develop Health Net business and system knowledge of business analysis, audit, and documentation staff.

Manage software vendor oversite activities including leading steering committees, development of business requirements and management of implementation projects.

Work directly with software vendor in implementing new technology and/or resolving ongoing systems and customer service issues.

Manages the daily operations of the Enrollment audit and documentation team, including analysis and database implementation of MOU contracts.
Coordinate and manage project plans to track test plans for system changes and upgrades, develop policies and procedures, and manage work flow. 
Coordinate training of staff in system changes, and interface with Management in documentation of all files/processes affected by system changes and the customers who receive them.
Ensures effective and responsive support for enrollment production systems upon which day-to-day operations of the department are dependent as non-compliance is subject to financial penalties and deficiencies.

Responsible for both internal and governmental reporting requirements of the Enrollment Department.

Represents department at Government and cross-functional meetings.



REQUIREMENTS:

 

Education:

Bachelors degree in related field preferred.

 

Certification/License: 

None required. 

 

Experience: Three to five years of increasing responsibility in health care analysis and health care management, with a minimum of three years managerial/supervisory experience. Three years or longer Health Net experience preferred.

Knowledge, Skills & Abilities: The Excellent oral and written communication skills, with the ability to express complex technical concepts clearly and effectively.Demonstrated ability to effectively interface with clients, staff and management, who possess a wide range of technical knowledge and experience. Previous experience in a position that required contact with clients in various disciplines would be viewed as a plus, since this position requires effective relationship building. Regional and national travel required. Must possess strong project management skills and ability to lead multiple projects simultaneously. Expertise must be demonstrated thorough understanding of project management principles, system and process design. Ability to formulate, analyze, interpret and communicate policies, processes, and regulations effectively across all areas of the business. Previous audit and documentation experience preferred Sarbanes Oxley or Third-Party Audit experience preferred

OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

 

As a government contractor, this position requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF85P or higher security

 

Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.

 

Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.