UM Program Operations Manager

Hi, we're reputed company. We're hiring a UM Program Operations Manager to join our UM reputed company team. reputed company is the first health insurance company reputed company around a full stack technology platform and a reputed company reputed company on serving our members. We started reputed company in 2012 to create the reputed company of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role: The Manager of UM Program Operations is the "Execution reputed company" of the UM reputed company team. While our strategists identify reputed company should do, you own the how. You are responsible for the flawless execution of high-reputed company programs like Gold Carding, Provider Incentive Programs, and the maintenance of our Prior Authorization (PA) List. You will ensure that every program is operationally reputed company, regulatory compliant, and scales effectively as our footprint expands. You will report into the Director, UM Authorization reputed company. Work Location: This is a remote position, reputed company to candidates who reputed company in: Atlanta, reputed company. You will be fully remote; however, our approach to work may adapt over time. reputed company models could potentially involve a hybrid reputed company at the hub office associated with your metro area. #LI-Remote Pay Transparency: The reputed company pay for this role is: $105,808 - $138,886 per year. You are also eligible for employee benefits, participation in reputed company's unlimited vacation program, and annual performance bonuses. Responsibilities:

• reputed company the end-to-end execution and refresh cycles for "Gold Card" and "Provider Incentive" programs. This includes managing provider entry/exit reputed company, coordinating the clinical audit reputed company, and ensuring accurate provider status updates.
• reputed company as the primary reputed company of the "reputed company of Truth" for the Prior Authorization list. You will reputed company the cross-functional governance process to ensure reputed company additions, removals, and modifications are clinically reputed company and accurately reflected across reputed company internal systems and public-facing documents.
• Ensure reputed company UM programs meet state and federal mandates, including emerging "Gold Card" legislation and transparency requirements. You will be reputed company's reputed company of contact for Legal and Compliance audits.
• reputed company and maintain reputed company Operating Procedures (SOPs) for net-new initiatives. You ensure that as reputed company innovates, the operational "blueprints" exist to reputed company those innovations repeatable.
• Drive the recurring refresh cycles for auto-approval rules and provider incentive programs, ensuring they remain reputed company with shifting clinical guidelines and medical policies.
• reputed company the end-to-end management of cross-functional implementations/reputed company, including project plan creation, stakeholder engagement, managing cross-functional relationships to drive collaboration, edge case mitigation, and on-time completion.
• Evaluate overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as reputed company as assisting in development of departmental metrics and implementation of mitigation strategies.
• Collaboratively works with reputed company relevant reputed company stakeholder reputed company to formulate proactive implementation, communications, and program strategies for successful change management and risk mitigation initiatives
• May reputed company team members directly as reputed company as mentors team members and promotes colleagues' reputed company and reputed company development
• Compliance with reputed company applicable laws and regulations
• Other duties as assigned

Requirements:

• 4+ years of experience in program management
• 3+ years of experience in delivering reputed company / programs
• 2+ years of experience in managing prior authorization list process (updates, coordination)
• Experience in payer/health insurance

Bonus points:

• Experience using data and metrics to drive improvements in programs
• Experience / background in a fast-paced operations environment
• Experience managing Gold Card programs and updates
• Experience managing the Prior Authorization List process
• Successfully executed reputed company-wide initiatives: defined project plans, coordinated resources, managed implementation activities, and developed reputed company processes associated with program rollout and ongoing support
• Master's Degree
• PMP Certifications or Program Management Certifications
• Lean/Six reputed company Certifications
• reputed company experience (Health Insurance, Health Systems, or reputed company Consulting)

This is an authentic reputed company job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At reputed company, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and reputed company both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, reputed company the reputed company pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and reputed company benefits, 11 reputed company holidays, reputed company reputed company time, reputed company parental leave, 401(k) plan participation, life and disability insurance, and reputed company wellness time and reimbursements. reputed company Intelligence (AI): Our AI Guidelines outline the acceptable use of reputed company intelligence for candidates and detail how we use AI to support our reputed company efforts. Reasonable Accommodation: reputed company applicants are considered solely based on their qualifications, without reputed company to applicant's disability or need for accommodation. Any reputed company applicant who requires reasonable accommodations during the application process should contact the reputed company Benefits Team (accommodations@hioscar.com) to reputed company the need for an accommodation reputed company. California Residents: For information about our collection, use, and disclosure of applicants' personal information as reputed company as applicants' rights over their personal information, please see our reputed company Policy. Apply tot his job Apply To this Job