Sentara

Compensation

Full Description

Sentara Health is seeking to hire a qualified individual to join our team as Director Health Plan Integration . Position Status: Full-time, Day Shift Position Location: Remote. Standard Working Hours: 8:00AM to 5:00PM (ET). Sentara Health is seeking to hire a qualified individual to join our team as Director Health Plan Integration. Expectations for this Role: Health Plan Integration Director Sentara Health Plans (SHP) is actively seeking a seasoned and strategic Health Plan Integration Director to orchestrate the seamless transition of M&A activity into the health plan infrastructure and shared services model. This role will also be responsible for leading the SHP Commercial claims migration to its future state platform - QNXT. This pivotal role is central to the organization's strategic initiatives to modernize its infrastructure, enhance operational efficiency, and ultimately improve member and provider experiences. It will serve as the central point of coordination across all functional areas including but not limited to: Operations, Sales, Network Management, Clinical, Finance, Communications, HR, IT, Vendor relationships, and Legal, ensuring strategic alignment and operational continuity during post-merger integration. The ideal candidate will be a meticulous planner with an operational mindset and an expert in data-intensive system migrations within the healthcare insurance landscape. They will assume ownership of the entire integration lifecycle, from initial strategy and planning through to execution, validation, and post-migration support. This position demands a unique blend of technical and business acumen, project management mastery, cross-functional leadership experience, and a deep understanding of health plan operations to deliver synergies, mitigate risks, and accelerate value creation. Key Responsibilities: • End-to-End Strategic Migration Planning: Develop and execute a comprehensive, end-to-end migration strategy and detailed project plan. This includes defining scope, timelines, resource requirements, risk mitigation strategies, KPI tracking framework, and rollback procedures. • Stakeholder Collaboration: Serve as the primary point of contact for all integration activities across people, process, and technology, fostering strong relationships and ensuring clear communication with internal and external stakeholders. Partner with executive leadership and functional leads to align integration strategy with corporate goals. • Data Integrity and Governance: Uphold the highest standards of data integrity, accuracy, and security throughout the migration process. This includes overseeing data mapping, transformation, cleansing, and validation to ensure a flawless transition. • System and Process Analysis: Conduct thorough analysis of existing claims processing systems and workflows to ensure all functionalities and business rules are accurately translated and configured in the new environment. Identify, prioritize, and execute synergy opportunities (cost savings, process optimization) • Testing and Validation: Lead all testing phases, including unit, user acceptance testing (UAT), claims comparison, and end-to-end testing to identify and resolve any discrepancies before and after the migration. • Team Leadership and Mentorship: Guide and mentor a cross-functional team of business leads, IT professionals, and PMO resources ensuring transparency and accountability while fostering a collaborative and high-performance environment. • Compliance and Regulatory Adherence: Ensure all migration activities comply with relevant healthcare regulations and standards, including but not limited to HIPAA, and state and federal mandates. • Documentation and Reporting: Maintain meticulous documentation of the migration process, including plans, procedures, and outcomes. Provide regular, transparent progress reports to senior leadership. Required Qualifications and Experience: • Bachelor's degree in Information Technology, Health Information Management, Business Administration, or a related field; MBA or equivalent preferred • A minimum of 7-10 years of experience in the healthcare industry, with at least 5 years in a leadership role managing large-scale, highly complex, data migration or system implementation projects in a matrixed environment for a health plan. • Proven experience in migrating claims data between major claims processing platforms (e.g., Facets, QNXT, HealthEdge). • Deep understanding of business functions (finance, HR, IT, sales, etc.) and how they interrelate during integration. • Ability to work under pressure and manage multiple workstreams simultaneously to achieve project goals on time and within budget. • Demonstrated expertise in project management methodologies (e.g., Agile, Waterfall) and proficiency with project management software. Desired Skills and Competencies: • Exceptional analytical and problem-solving abilities with a keen attention to detail. • Excellent communication, interpersonal, and presentation skills, with the ability to effectively communicate complex technical information to both technical and non-technical audiences. • Strong leadership and team-building skills, with a proven ability to motivate and guide teams to successful project completion. • Proficiency in data analysis and ETL (Extract, Transform, Load) concepts and tools. • A proactive and results-oriented mindset with the ability to manage multiple priorities in a fast-paced environment. This is a critical, high-visibility role that offers the opportunity to make a significant impact on the future of the health plan's operations. The successful candidate will be a strategic thinker, a hands-on leader, and a subject matter expert in the intricate world of health claims data.