Req ID: RQ207226
Type of Requisition: Regular
Clearance Level Must Be Able to Obtain: None
Public Trust/Other Required: MBI (T2)
Job Family: Process and Operational Efficiency
Skills:
Healthcare Management,Healthcare Operations,Health Plans,Operations Management,People Management
Experience:
7 + years of related experience
Job Description:
Contribute to the strategic direction of the business and support impactful mission outcomes as a Healthcare TPA Business Operations Manager at GDIT. Here, you'll enable the success of the most critical government missions and the growth of a meaningful career in Program Management.
As a TPA Business Operations Manager, the work you'll do at GDIT will be impactful to the mission of a federal health program. You will play a crucial role in ensuring patients receive quality healthcare.
This role is fully remote!
This role has a targeted start date towards the end of 2025/early 2026.
Responsibilities:
Plan, establish, execute, control, and optimize administrative healthcare business operations associated with a limited public health plan.
Oversee day-to-day operations of federal Health Program TPA activities, ensuring efficient service delivery and compliance with CMS and federal standards.
Ensure all operations related to Member and Provider Enrollment, Credentialing, Claims Administration, and Payments are delivered in accordance with SLAs and QASP metrics.
Drive delivery of business outcomes with the highest quality of care, equity, and stakeholder satisfaction.
Develop, implement, and monitor operational policies, SOPs, and performance dashboards to continuously improve service quality and program results.
Coordinate across clinical centers, administrative teams, vendors, and federal stakeholders to ensure seamless execution of program activities.
Manage budgets, resource allocation, workload distribution, and operational priorities to meet deadlines and ensure fiscal responsibility.
Monitor performance data, prepare leadership reports, and identify trends, risks, compliance issues, and opportunities for continuous improvement.
Oversee vendor and contractor performance, ensuring adherence to contractual obligations, SLAs, and compliance with HIPAA, and program requirements.
Lead operational readiness for new regulations, policies, services, and technology implementations, including change management and training.
Serve as a primary point of contact for escalated issues, member grievances, and provider concerns, driving timely resolution and root-cause analysis.
Manage a large team
Required Qualifications:
Bachelor's degree in healthcare administration, Public Health, Business Administration, or related field (Master's preferred).
7-10+ years in healthcare operations management, with at least 3-5 years in federal or public sector health programs (Medicaid, Medicare, VA, DoD, or CDC/NIOSH programs).
Strong knowledge of healthcare delivery systems, managed care operations, claims processing, and quality improvement methodologies.
Experience leading large-scale operations in a TPA, Medicaid Enterprise System (MES), or public health program.
Demonstrated success in managing budgets, contracts, SLAs, and performance metrics in a regulated environment.
Skilled in vendor/contractor oversight, procurement processes, and performance-based vendor management.
Strong understanding of healthcare regulations (HIPAA, ACA, Medicaid/Medicare rules, CMS QASP, NIST/FedRAMP security).
Proficiency with healthcare management systems (provider enrollment systems, claims adjudication systems) and data analytics tools (Power BI, Tableau, etc.).
Experience managing a large team.
Ability to obtain and maintain a Public Trust.
Preferred Qualifications:
Preferred certifications: CPHQ (Certified Professional in Healthcare Quality), PMP (Project Management Professional), Lean Six Sigma, ITIL, or CHC (Certified in Healthcare Compliance).
Excellent leadership, stakeholder engagement, and change management skills.
Ability to manage cross-functional teams, including clinical, operational, and IT resources.
GDITFedHealthJobs
The likely salary range for this position is $116,450 - $157,550. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.
Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee's date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.
We are GDIT. A global technology and professional services company that delivers consulting, technology and mission services to every major agency across the U.S. government, defense and intelligence community. Our 30,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50 countries worldwide, offering leading capabilities in digital modernization, AI/ML, Cloud, Cyber and application development. Together with our clients, we strive to create a safer, smarter world by harnessing the power of deep expertise and advanced technology.
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Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans
