Chief Operating Officer (COO)

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The Chief Operating Officer (COO) for the South Carolina Department of Health and Human Services (Department) serves as the operational leader for the Department. The COO provides the leadership, management and vision necessary to ensure that the Department has the proper operational controls, administrative and reporting procedures, and systems in place to effectively grow the organization and to ensure financial strength and operating efficiency. The position accomplishes this through a respectful, constructive and energetic style, guided by the performance objectives of the Department. This position reports directly to the Department Director.

• Performs fundamental supervisory and leadership functions in accordance with Department policies and procedures, best practices and Federal and State rules and regulations, especially with regard to Equal Employment Opportunity Commission (EEOC) standards. Maintains an effective organizational team and motivates diverse staff to accomplish mission critical operations and objectives. Promotes workforce engagement.
• The COO directs and oversees Medicaid Operations (MO), the functional unit responsible for operating the state’s $8 billion health plan through direct services, indirect vendors, and contracts with third-party health plans. Leads the team responsible for developing, operating, and incrementally improving a catalog services related to all operations functions within the agency, including beneficiary enrollment in health care plans, provider enrollment and engagement, payments to managed care organizations (MCOs) and for provider fee-for-service (FFS) claims, reference file administration, Health Information Technology (HIT) program administration, and performance improvement activities. The articulation of these services follows the Medicaid Information Technology Architecture (MITA) 3.0 business architecture. Activities within MO’s scope include the following service categories:
• Enrollment Broker
• Provider Enrollment and Management
• Provider Engagement
• Claims Escalation and Reconsideration
• MCO Capitation Payments and Plan operations
• Waiver Services Operations
• Nursing Home Payments
• Administrative Services Organization (ASO) Management
• Non-Emergency Medical Transportation (NEMT) Management
• Reference Administration Services
• Health Information Technology Services (HIT) Meaningful Use Payments
• Ensures that functional units maintain policies, procedures, and training materials in support of performance-based staff positions and evaluation criteria. Supports policy and finance units of the department by translating health plan policies and objectives into direct agency operations and systems or business requirements to be executed through vendors and key performance indicators for program and vendor evaluation.
• Establishes and maintains project management support systems to ensure consistent tracking and prioritization of departmental initiatives, deliverables due from program and support areas, and schedule. Coordinates with program and support areas to develop and track key performance indicators for departmental initiatives and projects. Reports to department director and deputy directors on project and initiative health with respect to scope, schedule, and budget, and develops root-cause analyses for under-performing projects and initiatives.
• Develops implementation schedules for routine policy updates, departmental initiatives, and break-fix interventions to ensure timely and complete implementation. Ensures implementation activities are coordinated across all agency verticals. Serves as a member of the agency’s executive management team and represents the interests and mission of effective implementation and operation of agency initiatives.
• Maintains capacity for process analysis, redesign, and continuous improvement of all repeatable and tactical agency operations. Identifies opportunities for process improvement and automation and performs cost-benefit analyses of such efforts for recommendation to agency leadership for approval.
• In addition to the required maintenance and continuous improvement of Medicaid Operations, contributes to the ongoing cycle of procuring and implementing third party administrators for claims and provider operations, pharmacy benefit management, dental services management, non-emergency medical transportation, case and care management, and others as necessary. Maintains staffing and scheduling in a manner sufficient to ensure relevant subject matter experts in the agency are available for the design, selection, and implementation of processes and vendors relevant to their area. Recommends strategies for succession planning to mitigate losses in institutional knowledge and area expertise.

MINIMUM AND ADDITIONAL REQUIREMENTS:

A bachelor’s degree and a minimum of ten (10) years of experience in Medicaid, health care, government, finance, or business management/administration; or a master’s degree and a minimum of nine (9) years of experience in Medicaid, health care, government, finance, or business management/administration. Must have at least seven (7) years of leadership responsibility in managing multiple, large, cross-functional teams or projects and influencing senior management and key stakeholders (management or director role).

All degrees must be from a higher education institution recognized by the U.S. Department of Education; Council for Higher Education Accreditation (CHEA). May accept an equivalent combination of education and relevant experience.

Must have and maintain a valid driver’s license.

Job Types: Full-time, Temporary

Experience:

• Medicaid, healthcare, government, finance, or business mgmt: 10 years (Preferred)
• leadership responsible for managing large projects: 7 years (Required)

Education:

• Bachelor’s (Preferred)

License:

• Driver’s License (Required)