Randstad Technologies is currently seeking a talented Senior Director Training and Quality Assurance to join a well-known client of ours within a location in the San Diego, CA area. Must be legally authorized to work in the U.S. without sponsorship.
Partners with the ED of the company's MC and other senior leaders on shaping the strategic goals and direction of the future state Training and Quality Assurance programs supporting Membership Administration. The scope of work encompasses all LOBs, regions, Regulatory and Compliance work.
location: San Diego, California
job type: Contract
salary: $72.22 - 81.25 per hour
work hours: 8am to 5pm
- Develops and deploys training to all Membership Administration resources to support the company's MC migration and ongoing training needs for new hires, upgrades/changes to systems and processes post-migration and overall training needs for MA staff to maintain optimal service and performance levels.
- Coordinates, plans, provides feedback and supports Membership Administration Training needs.
- Oversee the strategic design, development and implementation of training and development programs, including but not limited to onboarding, and leadership development and ongoing just-in-time training needs.
- Lead training initiatives, coaching and support within the organization up to and including leadership training and development.
- Conduct and maintain needs analysis mechanisms to identify training opportunities.
- Devise and implement change strategies and process improvements that align with business strategy, needs, and company culture.
- Build and maintain relationships and collaborate with MA management to uncover skill gaps and learning priorities with employees.
- Design, facilitate and manage training initiatives and programs that support the MA organization and align with the needs analysis.
- Support other talent management initiatives as required including employee development, workforce planning.
- Support all aspects of the career journey, from new hire training, to skill improvement, procedural changes, performance management.
- Develop enrollment, billing reconciliation training curriculum and recommend or utilize vendor programs that meet instructional goals and objectives.
- Formulate training outlines and determine instructional methods, utilizing knowledge of training needs and effectiveness of such methods as individual training, group instruction, meetings, workshops, e-learning, and virtual training.
- Experience in training and staff development with strong presentation and facilitation skills.
- Possess strong coaching/feedback skills as well as planning and organization skills.
- Ability to work well in teams and collaborate, problem solve and make timely decisions, and have experience working in a cross-functional environment.
- Provide all necessary orientation to new hires as well as on-going educational and learning opportunities for all employees through various in-services and training throughout the year.
- Maintain a supportive environment that will assist employees in gaining knowledge, skills and attitudes necessary to perform assigned duties effectively and with quality and service-oriented results.
- Membership transactions will be audited for service and quality at a statistically valid sampling that will include but is not limited to focused audits for financial, operational, compliance and specific Membership customer or internal requirements.
- Performs Quality Assurance of transactions (phone, manual and electronic inputs) for Membership Administration ensuring regulatory and service requirements individually and from an end-to-end process perspective are maintained - with statistically valid sampling.
- Works with external and internal compliance auditors to ensure the successful development, implementation and maintenance of all quality controls and service expectations. Provides quality results at an individual, team, and department level. Requests, tracks, and documents Corrective Action Plans that are developed by MA management.
- Works with external and internal compliance auditors and management to ensure the successful development, implementation and maintenance of all quality controls.
- Manages key data controls within Membership operations to ensure compliance with company procedures as well as regulatory agencies requirements; identifies quality trends and training needs.
- Responsible for monthly, quarterly and annual quality reviews. Provides detailed reporting to Membership Operations Leadership along with recommendations for training and quality improvements.
- Leads and shapes the development of Compliance and Audit standards including monitoring systems and processes across Membership Operations.
- Evaluates all current Quality systems and processes, recommends and implements enhancements and process improvement initiatives to ensure the achievement of the company's long-term objectives.
- Ensures the systems meet the needs of all internal and external constituencies with an emphasis on process, quality, financial control. Completes and conducts Quality Systems effectiveness reviews and analysis.
- Ensures compliance with SOX and all legal, regulatory requirements. Serves as Management Representative during audits (SOX, CMS others.) to ensure Quality System requirements are effectively established and maintained.
- Leads the Visual system validation of the field level accuracy of the Membership systems as well as employee-level accuracy tracking / reporting.
- Serves as the leading Training and Quality expert, providing solid, well-informed, actionable quality support to Membership Administration and other functions as requested. Utilizes, integrates, and interprets the Training and Quality data to assist Membership Operations in its improvement efforts. Works collaboratively with Senior Management to develop strategic Quality initiatives.
- Develops, implements and monitors Training and Quality programs, policies and procedures to ensure compliance with the standards, corporate policies, and regulatory guidelines.
- Works with IT executives, business executives and operations to facilitate go/no-go decisions on key initiatives.
- Manages financial aspects of the department; accountable for direct budget.
- Responsible for leading multiple teams, comprising the Training, Quality organization includes mentoring, coaching, selection, performance management and development of subordinate staff.
- Performs other duties and responsibilities as required or requested.
- Exercises considerable judgment to make decisions that impact Transactional and Service Quality, Compliance, and Audit programs. Involved in interpreting and analyzing established policies and/ or market trends and SOX requirements.
- Develops solutions to a diverse range of complex problems which require creativity and innovation within broadly defined policies. Requires in-depth analysis to identify and recommend new solutions to more complex problems.
- Work is accomplished without considerable direction. Exercises considerable latitude in determining objectives and approach to assignments.
- Direct responsibilities of large teams. Requires coaching, mentoring and development of teams.
- Must have strong leadership skills while also promoting teamwork.
- Minimum ten (10) years relevant work experience in the health care industry required.
- Minimum seven (7) years of management experience.
- Bachelor's degree in Healthcare or Business or related field or equivalent experience required.
- Must be computer literate in Microsoft Office.
- Must have excellent presentation/training skills, strong written and verbal skills.
- Able to manage enterprise-wide travel.
- The capability to motivate and take the lead in the decision-making process.
- Demonstrated ability to work in a team-based, collaborative environment.
- Must be able to work in Labor-Management Partnership environment.
- Microsoft Office, Power Point, and e-mail skills.
- Must have knowledge of health care delivery systems and Membership.
- Must have knowledge of leading quality assurance program, audit, and compliance experience.
- Large Health Plan experience preferred, preference in Membership.
- Experience leading a Quality, Compliance and Audit function for a large business unit in Health Care preferred.
- Master's degree in Healthcare or Business or related field preferred.
- EPIC Certification (s) preferred.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.