Oversees the administrative enrollment and disenrollment functions for the department. Collaborates on coordination of benefits, eligibility, engagement and enrollment activities. Oversees and coordinates internally and externally on enrollment, engagement and reconciliation activities. Works under general direction.
- Oversees the management of enrollment and disenrollment of members in managed care systems or value based programs. Reviews internal and external reports/rosters to ensure accuracy of membership and eligibility status. Oversees and/or participates in researching and resolving discrepancies. Monitors subsequent reports and activities to ensure internal/external reconciliation.
- Collaborates with leadership on key transformation initiatives to improve operating performance and gain efficiencies. Projects include, but are not limited to, development of new member onboarding processes and sustaining engagement and ongoing member experience.
- Identifies areas of opportunity and makes recommendations to better align member experience strategies with product vision, direction, and initiatives.
- Analyzes processes, reports problems/issues, and identifies contractual or regulatory performance issues to management.
- Manages, monitors and reconciles monthly census numbers. Summarizes data from pre-enrollment through membership.
- Oversees direct staff or collaborates internally in managing and maintaining eligibility for members. Provides direction and makes critical decisions regarding eligibility issues. Analyzes monthly reports and makes recommendations for change as necessary.
- Participates in the selection, design, testing and implementation of member services technology solutions. Identifies and evaluates new technologies and/or services to enhance performance and recommends appropriate uses. Ensures the effective installation and maintenance of new technologies and/or services to minimize disruptions.
- Prepares and analyzes reports regarding enrollment, engagement, referral and membership activities on a monthly basis for use by management to monitor/project plan growth, membership, trends and their impact on financial, operational and programmatic areas.
- Stays abreast of customer service industry trends and ensures VNSNY policies and procedures reflect the changes in the industry.
- Performs all duties inherent in a senior managerial role. Prepares and ensures adherence to the department budget.
- Performs other duties and participates in special projects as needed
Education:Bachelor’s Degree in Business, Health Administration or related discipline required. Master’s Degree in Business Administration or Health Administration or equivalent preferred.
Experience: Minimum of six years of progressively responsible operations experience required. Experience in the health insurance industry preferred. Minimum of five years of managerial experience preferred. Demonstrated knowledge of engagement or enrollment operations required. Excellent analytic, oral, written and interpersonal communication skills required. Excellent personal computer skills, including MS Excel and Word required.
The Visiting Nurse Service of New York (VNSNY) is the nation's largest not-for-profit home- and community-based health care organization, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Countries. For over 125 years, VNSNY has been committed to improving the health and well-being of people through high-quality, cost effective healthcare in the home and community. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, members, and clients from before birth to the end of life. Each day, more than 13,000 VNSNY employees - including nurses, rehabilitation therapists, social workers, other allied professionals, and paraprofessionals - deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 44,000 patients and members, helping them to live the best lives possible in their homes and communities.