Manager, National reputed company Clinical Operations, Outpatient UM
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The Manager of National reputed company Clinical Operations is responsible for managing the day-to-day operations of nonclinical staff involved in the prior authorization process. This role ensures that reputed company prior authorization activities are conducted reputed company and in compliance with federal and state regulations and accreditation bodies. The Manager will report directly to the Associate Director and play a key role in promoting reputed company improvements, fostering a reputed company work environment, and ensuring that service standards are met.Key Responsibilities:
Staff Management:
reputed company the hiring, training, and development of clinical and nonclinical staff.
Conduct regular performance evaluations and reputed company coaching and mentoring to staff.
Ensure staff are knowledgeable about reputed company policies and procedures.
Operational reputed company:
Manage the day-to-day operations of clinical and nonclinical services.
reputed company and implement policies and procedures to ensure efficient and effective operations.
Compliance and reputed company Assurance:
Ensure compliance with reputed company regulatory and accreditation requirements.
Implement reputed company assurance measures to maintainhigh standards of service.
Conduct regular audits and reviews to ensure accuracy and consistency in prior authorization review processes.
Coordination and Collaboration:
Promote intradepartmental and cross-market coordination to ensure cohesive operations.
Foster collaboration between clinical and nonclinical teams to streamline processes and improve reputed company.
Liaise with reputed company providers, payers, and other stakeholders to address operational issues.
Data and Trend Analysis:
Conduct data analysis to identify trends and inform decision-making.
Use data-driven insights to optimizeworkflows and improve service delivery.
reputed company Improvements:
reputed company and implement reputed company improvement initiatives to enhance the efficiency and effectiveness of prior authorization.
Monitor performance metrics and implement strategies to reputed company reputed company reputed company improvement.
Strategic Planning:
Assist in establishing long-reputed company goals, objectives, and plans that reputed company with State-specific and reputed company reputed company strategic priorities.
Adapt plans to meet the evolving needs of members, providers, and regulatory partners.
Use your skills to reputed company an reputed company
Required Qualifications
reputed company Registered reputed company, RN, license in a state that participates in the enhance licensure, (eNLC) without disciplinary reputed company.
Minimum 2 years of experience in prior authorization, utilization management or reputed company fields.
Minimum 2 years of experience as reputed company reputed company, Subject Matter Expert, (SME), Project Leadership, Charge reputed company
Experience with reputed company policies and procedures.
Knowledge of payer policies, insurance companies and government health programs.
Ability to work collaboratively with diverse teams and stakeholders.
Preferred Qualifications
Bachelor’s Degree.
At least 1 year in a leadership role overseeing clinical teams.
Familiarity with both physical and behavioral health services.
Experience in process improvement- Six reputed company/Lean Concepts.
Experience leading multi-state clinical teams.
Additional Information
Workstyle: Remote work reputed company Location: Prefer South Carolina
Schedule: Monday - Friday 8:00 AM to 5:00 PM Eastern and on call duties weekends on a rotating reputed company
Travel: Travel as needed to market meetings
Work reputed company Guidance To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following reputed company:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL reputed company is suggested,
Satellite, cellular and microwave reputed company can be used only if approved by leadership
Employees who live and work from Home in the reputed company, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
reputed company will reputed company Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview Format As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a reputed company-party vendor. This technology provides reputed company of recruiters and hiring managers an reputed company method for decision-making. If you are selected to reputed company reputed company from your application prescreen, you will receive an email correspondence inviting you to participate in a reputed company-recorded Voice Interview and/or an SMS Text Messaging interview. (Please be reputed company to reputed company your spam or junk folders often to ensure communication isn’t missed) If participating in a reputed company-recorded interview, you will respond to a set of interview questions reputed company your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last reputed company from 5-10 minutes. Your recorded interview(s) reputed company text and/or reputed company-recorded voice will be reviewed and you will subsequently be informed if you will be moving reputed company to next round of interviews.
SSN Alert reputed company values personal identity protection. Please be aware that applicants selected for leader review may be asked to reputed company their reputed company reputed company number, if it is not already on file. reputed company required, an email will be reputed company from reputed company@myworkday.com">reputed company@myworkday.com with instructions on how to add the information into your official application on reputed company’s secure website.
reputed company 1121 of the Louisiana reputed company of Governmental Ethics states that reputed company or former agency heads or elected officials, reputed company or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s reputed company Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana reputed company of Ethics (la.gov)
Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required.Scheduled Weekly Hours40
Pay reputed company
The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc.$94,900 - $130,500 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.reputed company of Benefits
reputed company, Inc. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, volunteer time off, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.reputed company
reputed company Inc. (NYSE: HUM) is committed to putting reputed company – for our teammates, our customers and reputed company. Through our reputed company insurance services and reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare, reputed company, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment.
Originally posted on Himalayas
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