Keystone Peer Review Organization, Inc.

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Director of Operations (Remote Opportunity) (Finance)



KEPRO is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting. KEPRO is seeking resumes for a highly experienced professional.

Director of Operations

Summary Description 

Manages the day-to-day operations for the HRSA Contract to include assuring timely achievement of contract deliverables, providing oversight of operational policy/procedure, assuming fiscal responsibility for revenue margins, ensuring excellent customer service/support and provide oversight/support for internal/subcontractor staff.

Accountabilities 

  • Establish/maintain effective relationships with HRSA staff; COR, Team Lead, Executive, and support.
  • Work collaboratively with interdisciplinary teams; analytics, IT, finance/accounting, FTCA deeming.
  • Work collaboratively with the VP, Quality Oversight to organize/direct the overall operations of the HRSA contract. Imperative to the role is strict adherence to organizational policy and procedure, federal guidelines/requirements.
  • Ensure compliance with and achievement of all contract deliverables per the contract SOW.
  • Collaborate with Finance/Accounting to ensure budgetary compliance, analyze variances, and assume fiscal responsibility for revenue margins.
  • Supervise all staff; ensure compliance with organizational P&P, assess training needs, address employee performance, develop CAPs as necessary, complete annual performance appraisals by established deadlines.
  • Actively participate in new employee recruitment, onboarding, orientation, supervision.
  • Actively participate in the recruitment of subcontractors, i.e., peer reviewers, deeming. Ensure completion of training requirements and collaborate with contracts in securing subcontracting agreements. 
  • Prepare quarterly Board of Director PowerPoint presentations; present/discuss with executive staff as required.
  • Attend and facilitate monthly Kepro Operational/HRSA team meetings, and other meetings as required.
  • Serve as Chair of the LQIC; attend/facilitate quarterly LQIC meetings, annually review/update team P&P.
  • Review/approve all monthly/quarterly/annual/ad hoc/deeming/actuarial reports prior to distribution to HRSA. (And all other reports as required by the contract)
  • Complete monthly claims auditing/QIP ensuring results are captured in Kepro's metrics database.
  • Actively participate with Medical Claims Review Panel (MCRP) preparation; review/approve agenda entries, recruit/retain/train/schedule panel presenters, approve presenter timesheets.
  • On a daily basis, assess and evaluate the work que (Tickler) and adjust staffing schedules to ensure production of reports within the HRSA-established deadlines.
  • Prepare monthly budget variance reports; participate in weekly/monthly finance meetings to ensure fiduciary compliance/program financial success.
  • Review/approve all timesheets including those submitted by internal staff, peer reviewers, all subcontractors (Deeming, Program Advisor, Actuarial, etc.)
  • Interface with HRSA's Deeming Program team to ensure a complete/timely/accurate/successful deeming cycle; attend all meetings during the annual cycle to include all trainings, weekly prep, weekly subcontractor, others as required by HRSA.
  • Collaborate with the Medical Director to ensure quality and timeliness of Expert Medical Reviewer (EMR) reporting.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time. 

Supervisory Responsibility

  • RN Nurse Reviewers
  • Administrative Assistants
  • Manager, HRSA FTCA Deeming Program
  • Program Clinical Advisor
  • Health Center Program Advisor
  • Peer Reviewer/Deeming Subcontractor staff 

Qualifications 

  • Graduation from School of Professional Nursing.
  • BSN required, advanced degree preferred; MSN, Juris Doctorate, Certification in Healthcare Administration.
  • Prior nursing experience in an acute care setting.
  • Claims Management/Risk Management preferred.
  • Current, valid, unencumbered Pennsylvania RN license.

Knowledge, Skills, Abilities 

  • Demonstrable experience in personnel management; recruitment, onboarding, employee development, performance management.
  • Decisive leadership with excellent decision-making skills.
  • Ability to participate as a team member fostering collaborative decision-making among leadership, committees, teams or work groups of diverse composition.
  • Attentiveness to detail/accuracy, organized.
  • Effective communication skills.
  • Ability to anticipate critical issues and design effective interventions.
  • Knowledge of the U.S. healthcare industry; preferably with experience in both public and private sector.
  • Commitment to the corporate mission and strategic plan.
  • Knowledge of business development, strategic planning, tactical implementation and creation of business partnerships.

Experience 

  • 10 years of experience in healthcare/risk management field.
  • 3 to 5 years of recent management experience.
  • Previous experience writing Quality Improvement Reports, i.e., medical chronologies, claim/risk Management/reserve reports.
  • Previous experience establishing accurate loss reserves in a medical negligence claims setting.
  • Previous credentialing/deeming experience.
  • Public and private sector healthcare experience and/or involvement in providing services to government or commercial programs.

Mental and Physical Requirements               

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

KEPRO offers challenging careers, excellent benefits and opportunities for advancement.  For consideration, please submit resume and cover letter with salary requirements. Only those candidates identified for an interview will be contacted. No Phone Calls Please.  Visit our website at www.KEPRO.com for more information on the KEPRO Family of Companies.   

EOE AA M/F/Vet/Disability

KEPRO is an Equal Opportunity Employer.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

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