Department: Administration - UH

FTE: 1.00
Full Time
Shift: Days

Position Summary:
The Chief Administrative Officer (CAO) is responsible for leading and managing the UNMCare Health Plan, ensuring that it delivers high-quality, cost-effective services. This role involves strategic planning, operational oversight, financial management, and stakeholder engagement to drive improved health outcomes for its members. The CAO will work closely with other senior leaders to ensure the efficient and effective delivery of exceptional, patient centered care and high-quality access and outcomes. Oversees the administration, compliance and operational functions of the plan, ensuring that it operates efficiently and in accordance with all federal, state, local, and regulatory requirements. Ensure adherence to UNM Hospitals and departmental policies and procedures. No patient care assignment.

Detailed responsibilities:
* OPERATIONS – Oversee the daily operations of the UNMCare plan, ensuring effective delivery of services and programs to members
* STRATEGIC PLANNING – Develop and execute the strategic vision and direction of the UNMCare plan in alignment with organizational goals and industry trends; develop long and short-range plans; provide leadership in the design and implementation of new initiatives
* SERVICES - Develop initiatives necessary to integrate and expand services; add potential new services to meet the growing healthcare needs of the members served, including expansion of provider access in primary and ambulatory care
* PROVIDER RELATIONS – Develop and maintain a system of planned and tracked provider contact to promote clinical service lines and serve to mitigate provider issues. Develop and implement provider feedback optimization to ensure effective communication
* OVERSIGHT – Ensure monitoring and oversight processes are in place to measure, evaluate, and report on operations and activities pertaining to the UNMCare plan; monitors data and key performance indicators to understand variables and implements corrective action when and where appropriate; analyzes data to make fact-based decisions and monitors variances to understand trends
* POLICIES – Implement and monitor operational policies and procedures to enhance efficiency, quality, and member satisfaction
* CONTRACTS - Oversee the negotiation and establishment of contract language and legal requirements in compliance with policies, industry standards and other Federal laws and regulations
* REGULATORY – Ensure the UNMCare plan’s strategy aligns with regulatory requirements, industry standards and best practices; ensure compliance with all relevant laws, regulations, and accreditation standards; stays informed about changes in healthcare regulations, trends and emerging issues; design reporting required by regulatory bodies and any key vendors as needed; ensure compliance with regulatory requirements, accreditation standards, and contractual obligations related to plan operations; oversee risk adjustment compliance and documentation integrity oversight
* TRENDS - Stay informed about industry trends, emerging technologies, and regulatory changes affecting health plan operations, recommending appropriate strategies and initiatives
* RISK – Develop and implement risk management strategies to identify and mitigate potential risks
* IMPROVEMENTS - Continuously seek improvements to processes and systems across functions
* BUDGET – Works with the Chief Financial Officer and other stakeholders to develop and manage UNMCare’s budget, ensuring financial stability and sustainability
* FINANCE – Monitor financial performance, including revenue, expenses and profitability; take corrective action as necessary: assess opportunities for revenue and administrative savings; develop and implement strategies; evaluate and consolidate contracts; provide cost benefit analysis and other related reports
* METRICS - Establish, monitor and analyze operational performance metrics and key performance indicators identifying trends, risks, and opportunities for improvement; design and support reporting needed by the operations teams (e.g., Quality, Risk Adjustment, Utilization Management)
* CONSULT – Consult with and advise Administration and other appropriate stakeholders regarding plan issues or legislation that may impact operations
* REPORTING – Communicate goals, strategies and performance at relevant committee meetings, the Board of Trustees, employees and other stakeholders
* LIAISON – Represent as a liaison to the New Mexico Medicaid Division and other areas of State and Federal government to provide information or support operational and strategic objectives
* SPOKESPERSON – Act as the primary spokesperson for the UNMCare plan, representing in public forums and other venues as directed
* MEMBER RELATIONS – Enhance member satisfaction by ensuring high-quality service delivery and addressing member concerns and needs; promote initiatives that improve health

Education:
Essential:
* Master's Degree
Education specialization:
Essential:
* Related Discipline

Experience:
Essential:
10 years progressively increasing administrative experience

Nonessential:
No preferred experience

Credentials:

Physical Conditions:
Sedentary Work: Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Working conditions:
Essential:
* No or min hazard, physical risk, office environment
* Subject to an annual contract and performance appraisal