Job Summary:
The Manager, Health Partner Life Cycle Operations is responsible for managing day-to-day operations of direct reports to ensure department goals and tasks are achieved.
Essential Functions:
- Continually review data entry processes; implementing process improvements to ensure effectiveness when appropriate
- Participate in key committees, subcommittees, and/or work groups, as necessary
- Develop and implement processes to monitor key metrics to ensure accuracy of data, process efficiency and staff performance
- Develop departmental training and evaluation techniques
- Responsibility for maintaining all provider networks as assigned
- Provide back-up services to departmental positions, as needed
- Ensure timely processing of provider networks and maintenance activities
- Manage network requirements for RFA ‘s / RFP’s
- Perform metrics analysis related to provider networks, claims processing and other related operational performance
- Provide leadership and direction for the multi-state, multi-product teams across internal and external databases
- Manage the relationship with IT as required for implementation of initiatives for process improvement through automation within Health Partner Life Cycle (HPLC)
- Perform cost-benefit and return on investment analyses for proposed initiatives to aid decision-making process as well as collect and analyze data in support of business case creation and realization
- Perform research into quality, grievance, fraud and abuse or malpractice issues for providers as needed
- Ensure HPLC activities comply with URAC, NCQA, state and federal regulations
- Coordinate, produce and analyze management reports and incorporate changes as requested to enhance reporting and/or improve workflow and monitor for trends and patterns
- Communicate with and provide regular updates to Senior Leadership
- Demonstrate strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner
- Perform any other job related instructions, as requested
Education and Experience:
- Bachelor of Science degree in business related field or equivalent years of relevant work experience is required
- Minimum of five (5) years of experience in a healthcare environment is required
- Experience in Provider Services is preferred
- Minimum of three (3) years leadership experience is required
Competencies, Knowledge and Skills:
- Proficient with Microsoft Office to include Word, Excel and PowerPoint
- Proficiency in using Facets provider application
- Understanding of Facets Claims processing, provider configuration and network configuration
- Understanding of provider contracting process, provider credentialing process, provider directory operations and network adequacy reporting
- Knowledge of compliance requirements in provider data operations space required including, but not limited to, NSA and ACA
- Excellent written and verbal communications skills
- Ability to develop, prioritize and accomplish goals
- Strong interpersonal skills and high level of professionalism
- Effective listening and critical thinking skills
- Effective problem-solving skills with attention to detail
- Ability to manage and prioritize multiple tasks
- Knowledge of SQL to build / run queries is preferred
Licensure and Certification:
Working Conditions:
- General office environment; may be required to sit/stand for long periods of time
Compensation Range:
$79,800.00 - $127,600.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.