Director, Health Plan Integration
Director, Health Plan Integration
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Job Description
City/State
Virginia Beach VAWork Shift
First (Days)Overview:
Sentara Health is seeking to hire a qualified individual to join our team as Director Health Plan Integration .
Position Status: Full-time Day Shift
Position Location: Remote.
Standard Working Hours: 8:00AM to 5:00PM (ET).
Sentara Health is seeking to hire a qualified individual to join our team asDirector Health Plan Integration.
Expectations for this Role:
Health Plan Integration Director
Sentara Health Plans (SHP) is actively seeking a seasoned and strategic Health Plan Integration Director to orchestrate the seamless transition of M&A activity into the health plan infrastructure and shared services model. This role will also be responsible for leading the SHP Commercial claims migration to its future state platform - QNXT. This pivotal role is central to the organizations strategic initiatives to modernize its infrastructure enhance operational efficiency and ultimately improve member and provider experiences. It will serve as the central point of coordination across all functional areas including but not limited to: Operations Sales Network Management Clinical Finance Communications HR IT Vendor relationships and Legal ensuring strategic alignment and operational continuity during post-merger integration.
The ideal candidate will be a meticulous planner with an operational mindset and an expert in data-intensive system migrations within the healthcare insurance landscape. They will assume ownership of the entire integration lifecycle from initial strategy and planning through to execution validation and post-migration support. This position demands a unique blend of technical and business acumen project management mastery cross-functional leadership experience and a deep understanding of health plan operations to deliver synergies mitigate risks and accelerate value creation.
Key Responsibilities:
- End-to-End Strategic Migration Planning: Develop and execute a comprehensive end-to-end migration strategy and detailed project plan. This includes defining scope timelines resource requirements risk mitigation strategies KPI tracking framework and rollback procedures.
- Stakeholder Collaboration: Serve as the primary point of contact for all integration activities across people process and technology fostering strong relationships and ensuring clear communication with internal and external stakeholders. Partner with executive leadership and functional leads to align integration strategy with corporate goals.
- Data Integrity and Governance: Uphold the highest standards of data integrity accuracy and security throughout the migration process. This includes overseeing data mapping transformation cleansing and validation to ensure a flawless transition.
- System and Process Analysis: Conduct thorough analysis of existing claims processing systems and workflows to ensure all functionalities and business rules are accurately translated and configured in the new environment. Identify prioritize and execute synergy opportunities (cost savings process optimization)
- Testing and Validation: Lead all testing phases including unit user acceptance testing (UAT) claims comparison and end-to-end testing to identify and resolve any discrepancies before and after the migration.
- Team Leadership and Mentorship: Guide and mentor a cross-functional team of business leads IT professionals and PMO resources ensuring transparency and accountability while fostering a collaborative and high-performance environment.
- Compliance and Regulatory Adherence: Ensure all migration activities comply with relevant healthcare regulations and standards including but not limited to HIPAA and state and federal mandates.
- Documentation and Reporting: Maintain meticulous documentation of the migration process including plans procedures and outcomes. Provide regular transparent progress reports to senior leadership.
Required Qualifications and Experience:
- Bachelors degree in Information Technology Health Information Management Business Administration or a related field; MBA or equivalent preferred
- A minimum of 7-10 years of experience in the healthcare industry with at least 5 years in a leadership role managing large-scale highly complex data migration or system implementation projects in a matrixed environment for a health plan.
- Proven experience in migrating claims data between major claims processing platforms (e.g. Facets QNXT HealthEdge).
- Deep understanding of business functions (finance HR IT sales etc.) and how they interrelate during integration.
- Ability to work under pressure and manage multiple workstreams simultaneously to achieve project goals on time and within budget.
- Demonstrated expertise in project management methodologies (e.g. Agile Waterfall) and proficiency with project management software.
Desired Skills and Competencies:
- Exceptional analytical and problem-solving abilities with a keen attention to detail.
- Excellent communication interpersonal and presentation skills with the ability to effectively communicate complex technical information to both technical and non-technical audiences.
- Strong leadership and team-building skills with a proven ability to motivate and guide teams to successful project completion.
- Proficiency in data analysis and ETL (Extract Transform Load) concepts and tools.
- A proactive and results-oriented mindset with the ability to manage multiple priorities in a fast-paced environment.
This is a critical high-visibility role that offers the opportunity to make a significant impact on the future of the health plans operations. The successful candidate will be a strategic thinker a hands-on leader and a subject matter expert in the intricate world of health claims data.
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus ifestablished system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30000-member workforce. Diversity inclusion and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission to improve health every day this is a tobacco-free environment.
For positions that are available as remote work Sentara Health employs associates in the following states:
Alabama Delaware Florida Georgia Idaho Indiana Kansas Louisiana Maine Maryland Minnesota Nebraska Nevada New Hampshire North Carolina North Dakota Ohio Oklahoma Pennsylvania South Carolina South Dakota Tennessee Texas Utah Virginia Washington West Virginia Wisconsin and Wyoming.
Required Experience:
Director
Employment Type
Full-Time
