Responsible for the oversight of healthcare management staff including the organization and development of high performing teams.
Works closely with functional area managers to ensure consistency in health related and psycho-social interventions supporting our members and is accountable for meeting the financial, operational and quality objectives of the unit.
Oversee the implementation of healthcare management services for assigned functional area. Accountable for maintaining policies & procedures in accordance with applicable regulatory and accreditation standards and implementing them at the employee level (e.g. NCQA, URAC, state and federal standards and mandates as applicable).
Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care.
May act as a liaison with other key business areas.
Manage resources responsible for improved health care decision making, enhancement of member impact, and leveraging technology.
May have responsibility for member escalation cases.
May act as a single point of contact for the customer and the Account Team including: participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
Assess developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams.
Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance. Consistently demonstrate the ability to serve as a model change agent and lead change efforts.
Collaborate with licensed staff from other areas that assist with oversight of clinical staff and activities of licensed personnel. Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking.
2 years leading claims/customer service team.
Experience with claims/call center environment.
Bachelor's degree required.
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