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One Mission. Half a Million Reasons.
As we empower every New Yorker
to live the healthiest life possible.

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Job Details

Director of Core Systems Operations

Job Ref: 56353
Category: Information Technology
Location: 160 Water St. #3, New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $150,000.00
Salary Range: $150,000.00 - $190,000.00

Marketing Statement

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview 

The Director of IT Core Applications is responsible for evaluating operation processes and procedures for process improvement of MetroPlus Core Applications. Will work with claims editing applications and vendors, Claims Operations, Utilization Management, and Network Management to setup system edits. 

Job Description

  • Oversee development and implementation of short/long term business objectives
  • Direct and support initiatives to focus on projects with plan wide benefit in accordance with corporate budgetary objectives
  • Ensure continuous delivery of IT services through oversight of service level agreements and monitoring of IT systems vendor performance
  • Oversee functions performed by delegated vendor as it relates to benefit configuration, claims processing, provider setup and account payable system
  • Manage activities and communications between key business stakeholders and Core System Vendor for implementation of new systems and optimization of current systems
  • Develop and oversee SDLC methodology, including business requirements creation and sign off, Quality Assurance, User Acceptance Testing, Production and Postproduction activities
  • Address operational matters by working with business units to identify system solution to operational issues
  • Participate and advise in new business/operational initiatives
  • Provider guidance on current and future system capabilities
  • Collaborate with operational areas and the system vendor to create system enhancement road map
  • Identify areas of operational improvement, promote strategic relationships with business areas, vendor, governmental and partner organizations
  • Work with claims editing vendors, Claims Operations, Utilization Management, and Network Management to setup system edit to increase medical cost savings 
  • Facilitate improvement of the payment transaction process by interacting with providers and finance team
  • Manage project implementation of upgrades and new products as it relates to Core Systems
  • Manage production processes, regulatory reports submission and provider directory activities

Minimum Qualifications

  • Bachelor’s Degree from an accredited college or university in Information Systems, Computer Science, Healthcare IT or related field
  • A minimum of 15 years Data Processing related experience 
  • Healthcare IT experience required 
  • Project Management and Staff Supervision a plus

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication