Manager
Advantasure

Job Info

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SUMMARY:

The Manager is responsible for management of staff who provide analysis and support on behalf of Medicare Advantage for Medical Management, Quality Improvement and other programs requiring clinical oversight. This position provides effective and efficient solutions to complex business problems with delivery of key presentations/concepts, business reviews, and business development recommendations. This position's responsibilities include maintaining effective relationships with Health Care Values, Program Oversight, and other key vendors, and partners to ensure that the issues and needs of Medicare Advantage are represented and prioritized in all clinical programs. This role is also responsible for strategizing, innovating, analyzing, planning, organizing, budgeting, reporting, identifying equipment needs, and other functions that are required to maintain and operate an efficient and effective team.

RESPONSIBILITIES/TASKS:

• Acts as MA PPO liaison with HCV for all medical management programs and issues
• Responsible for the successful execution of the Quality Improvement Program in accordance with CMS requirements including development, management and submission of Chronic Condition Improvement Program (CCIP) and the Quality Improvement Plan (QIP) as well as the annual work plan and evaluation.
• Acts as primary point of contact for all related compliance audits on behalf of medical management programs including organization determinations, timeliness, and readiness.
• Acts as key MAPPO point of contact with Tessellate for HEDIS reporting and audits.
• Responsible for leading periodic reporting and analysis of Hospital Acquired Conditions (HACs)
• Plans, organizes, and directs activities of Medical Management and Clinical Oversight team, including, but not limited to, planning, training, motivation, staff development, staff selection, and communication.
• Provides or orchestrates the provision of subject matter expertise and support related to medical management inquiries within requests for proposals and customer presentations
• Maintains and promotes quality relationships with internal and external customers.
• Compiles and analyzes statistics and prepares activity related reports, manpower needs, and inventories and monitors all workflows within the unit.
• Leads and participates in workgroups and task forces in order to complete special assignments and projects.
• Resolves CMS or other inquiries resulting from jeopardy situations - including issues of non-compliance with related vendors or programs.
• Recommends processes to control expenditures and promotes efficient use of resources.
• Participates in development of annual departmental budget, monitors budget, and identifies budget discrepancies. Researches cause and makes recommendations.
• Responsible for balancing workload to optimize the effectiveness of the department.

DIRECTION EXERCISED:

Directly supervises exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Bachelor's degree in Business Administration, Health Care Administration, Marketing, or a related field. Master's degree in a related field is preferred. Clinical background (e.g. RN) and/or CPHQ certification helpful but not required. Relevant combination of education and experience may be considered in lieu of degree. Valid and unrestricted driver's license is required. Continuous learning, as defined by the Company's learning philosophy, is required.

EXPERIENCE:

Seven years of experience with progressive responsibility in a business environment with demonstrated technical knowledge that provides the necessary knowledge, skills, and abilities required. Three years supervisory or lead experience in business required.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Ability/willingness to develop, recommend and execute solutions to ad hoc issues and challenges that may arise.
• Strong knowledge of quality improvement processes and concepts.
• Subject matter expertise in Medicare Advantage and medical management (i.e. Utilization Management, Care Management, etc.).
• Ability and willingness to delegate, guide and oversee work of team on projects.
• Excellent analytical, organizational, planning, verbal, and written communication skills required.
• Proficient in work that involves analysis, organization, planning, presentation development, problem resolution, sales, strategy, and innovation.
• Knowledge of BCBSM and BCN product and medical management programs to effectively manage staff.
• Must be self-motivated and have the ability to work well under pressure.
• Ability to effectively present information and respond to questions from internal and external contacts at all levels of the organization.
• Ability to read, analyze, write, and develop communications (i.e. white papers, strategy decks, etc.) or reports as required by leadership.
• Proficient in current industry standard PC applications and systems.
• Extensive knowledge of operations.
• Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management.
• Ability to work with and empower others on a collaborative basis to ensure success of unit team.
• Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques.
• Ability to effectively present budgetary and/or cost information, and respond to questions as appropriate.
• Ability to establish workflows, manage multiple projects, and meet necessary deadlines.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Occasional travel is required.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.

This job has expired.