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Metastar | Director of Commercial Services

January 12, 2022 6:12 PM | Mathias Lemos Castillo (Administrator)


Job Title:  Director of Commercial Services

Division and/or Department: Commercial Services

Date Most Recently Reviewed/Updated:  12/28/2021

Pay Type:  Salaried 

Workforce Classification:  Full time

JOB SUMMARY 

  • Reports directly to:  Chief Operating Officer
  • Direct reports to this position include:
    • Performance Measurement (PM) Audit Program Manager
    • Privacy and Security Lead
    • Contracted Vendors (Coding Firms, Subcontractors, etc.)
  • Other individuals or MetaStar staff with whom the person works on a regular basis: 
    • Audit Program Leads -- HEDIS compliance audits (HEDIS), Medicare Part C&D Data Validation (DVA) Risk Adjusted Initial Validation Audit (IVA), URAC Accreditation Data Validation (URAC) service lines
    • Audit Systems Analyst
    • Operations Specialist
    • External Partners (PSRx, Acentrus, etc.)
    • IT Staff
    • Communication and Marketing Staff
    • Operations Team
    • External Regulators (NCQA, CMS, URAC, etc.)
  • Essential duties and responsibilities: 

To successfully perform this job, the individual must be able to perform each essential job function satisfactorily.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

  • Oversight of all commercial services, including HEDIS, DVA, URAC, IVA, other audit work, and Privacy and Security risk assessments
  • Monitor staff performance, and work with direct reports to establish performance expectations
  • Build and maintain business partner and customer relationships 
  • Have and maintain a strong working knowledge of the commercial services performed (HEDIS, DVA, IVA, URAC, Privacy and Security)
  • Serve as primary contact for regulatory agencies (NCQA, CMS) 
  • Responsible for developing budgets and meeting department financial performance expectations 
  • Grow and develop commercial services service lines including identifying opportunities, attending appropriate conferences, leading the proposal process, contracting and renewals, maintenance of CRM, and coordination of marketing and outreach efforts
  • Monitor landscape and stay up-to-date with regulatory and compliance requirements to be responsive to new opportunities
  • Perform competitive analysis and benchmarking
  • Provide strategic direction and guidance to leadership for all commercial service lines
  • Recruit, train, develop, and provide oversight of all personnel in the department, supported by the Manager/Lead(s)
  • Lead in accordance with MetaStar’s values and culture
  • Ensure adequate resources to efficiently and effectively perform the work
  • Participate in organization-wide leadership teams such as Operations 
  • Oversee and project manage IT projects for all Commercial Service lines.
  • Utilize the Baldrige Excellence Framework to promote standardized processes, improvement, innovation, and measurement and reporting, including the development and monitoring of Key Performance Indicators
  • Resolve any potential conflict of interest situations proactively and collaboratively
  • All other duties as assigned

QUALIFICATIONS, REQUIREMENTS, ETC. 

The requirements listed below are representative of the knowledge, skills, and/or abilities required to successfully perform this job at the minimum level. Additional requirements are listed as preferred.

  • Minimum of a Bachelor’s Degree in health care, business administration, or related field  
  • 5+ years of previous leadership experience including involvement in strategic planning 
  • Specific experience related to HEDIS, DVA, URAC, IVA, other health care related audit work, and/or Privacy and Security risk assessments is preferred.
  • Experience with staff development and resource management
  • Experience managing multiple projects/priorities and complex activities
  • Must be able to troubleshoot issues and propose solutions
  • Ability to establish and maintain credibility with the team
  • Excellent communication skills, both verbal and written. Includes experience making presentations and exhibiting at conventions
  • Self-motivated, critical thinker with a strong desire to learn and apply existing and new skills
  • Proficiency in Microsoft Office applications include Dynamics CRM 
  • Strong initiative and a proactive approach to work and challenges
  • Ability to apply quality improvement mindset and approaches
  • Strong analytical, process improvement, team building, and project management skills
  • Ability to develop strong professional relationships with customers
  • Valid driver’s license or ability and means to travel, and availability for in-state and overnight travel as needed (it is anticipated that travel would not exceed 15% of the work schedule)
  • As a federal contractor proof of COVID-19 vaccination is required for all employees

ORGANIZATIONAL CORE COMPETENCIES: 

  • Exemplifies MetaStar’s Mission, Vision, Values
  • Uses Quality Improvement Concepts in Daily Practice
  • Provides Excellent Customer Service
  • Shows Initiative
  • Applies MetaStar’s Management Philosophy

PHYSICAL EFFORT AND WORKING CONDITIONS

The requirements and conditions described below are representative of the general environment the individual is exposed to on a day-to-day basis while performing this job.


Manual Dexterity: Ability to operate computer and telephone

Physical Effort: Ability to sit or stand for five-to-eight hours per day (depending on scheduled FTE); occasionally lifting up to 15 pounds.

Equipment Used: Computer and telephone

Working Conditions: Traditional office environment; required to work on a computer five-to-eight hours per day (depending on scheduled FTE)


MetaStar is proud to be an equal opportunity employer. We do not discriminate based upon race, religion, color, national origin, sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other characteristics. We celebrate diversity and are committed to creating an inclusive environment for all employees.


Please send your resume to jobs@metastar.com.  Additional information on our benefits and culture can be found at Careers - MetaStar.

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