Posted 10 days ago
Description
PM Compliance and Regulatory Initiatives
Manager of DSE Provider Network Operations will report directly to the Director for DSE Operational Solutions and leads a team of Network Quality Specialists and Network Operations Specialists that are responsible for managing core functions within DSE such as quality assurance auditing, contract implementation and creation, and oversight of departmental policies and procedures.
The Manager partners with business leaders to drive coordinating process improvements focused on increasing efficiency and reducing costs through the application of process improvement, quality tools and methodologies. This includes creating and managing process efficiencies that contribute to reduction in medical costs.
Duties & Responsibilities
- Organizes and leads assigned process improvement projects using methods of team building, data gathering and analysis, process mapping, and problem solving
- Works with appropriate stakeholders to develop and document key processes within DSE
- Manages regular quality assurance audits on audit failures to ensure appropriate resolution has occurred (i.e. Access and Availability, compliance with documented policies and procedures)
- Partners with DSE teams (i.e., Ancillary, Hospital, Physicians) to coordinate implementation of new contract terms
- Understands underlying system set-up issues and offers recommendations (i.e., Contract loading, provider id set up)
- Establishes and maintains excellent working relationships with corporate departments (i.e., Provider Operations, Regulatory, Compliance, Reimbursement)
- Manages the integrity of SharePoint and workflows associated with team deliverables
- Responsible for publishing reports from all work tracked in assigned section of SharePoint
- Effectively communicates results to key stakeholders
- Creates presentations and presents as needed on issues, projects, audits conducted
- Tracks trends in unresolved audit findings to reduce exposure to negative external audit findings
- Serves as the SME on process improvement
- Partners with Directors/Managers in DSE to review quality assurance findings
- Conducts monthly presentations on the unit’s performance and results
- Manages report requests and tracks progress and completion dates
- Manages a team of professionals and is responsible for supervision, coaching, performance management, and oversight
- Conducts ad hoc analysis related to explaining root cause drivers
- As determined by the Director of DSE Operational Solutions may be forward facing with providers as needed
- Additional duties as assigned
Minimum Qualifications
- High School Diploma
- Experience in Managed Care operations; working with various business partners to facilitate resolution (Legal, Regulatory/Compliance, Quality)
- Project planning of small and large scale initiatives
- Familiarity with implementing corrective action plans and recommending approaches on how to improve efficiency in process flows
- Great attention to detail
- Creating presentations and presenting to management
- Managing a team of direct reports
- Critical thinking skills
- MS Excel, Word, Power Point
Seniority Level
Executive
Employment Type
Full-time
Job Function
Project Management and Information Technology
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