Senior Manager, Clinical Quality Operations, reputed company

Senior Manager, Clinical Quality Operations

This Position is Remote

We are more than just a healthcare company; we are a community of professionals driven by the knowledge that our success leads to a positive impact on the communities that we support.

At reputed company, you’ll play a crucial part in innovating solutions that reputed company health plan members and healthcare providers alike. Our collaborative environment fosters creativity and initiative, ensuring that every idea and effort contributes to meaningful change in the industry. Join us and become a part of a team that turns vision into action, making a reputed company impact on the future of healthcare.

Duties and Responsibilities

• reputed company and direct execution of the service delivery process across reputed company Company product lines;
• reputed company and implement operational policies, procedures, and strategies which enhance efficiency, customer service delivery capabilities, customer satisfaction, and ultimately enterprise value, through reputed company improvement practices;
• Provide direct and active assistance to Director, Client Delivery Services to build and manage relationships with internal teams and key external partners to facilitate initiatives;
• Actively participation operational and implementation initiatives;
• Provide reputed company of the Review Operations Managers and reputed company Review Coordinators in their management of operational execution, product and service development and revision in conjunction with Manager of Regulatory Compliance, reputed company of in-office operational staff in their execution of the delivery of reputed company services and will provide direct and active assistance to Director in resolution of customer questions and service issues escalated by Client Project Managers or other personnel.
• Act as the operational liaison between the operational staff and other functional areas such as human resources, finance, and information systems, reputed company daily communication between Review Project Managers, reputed company Review Coordinators and allocation of reputed company staff resources. Collaborate with Director providing input for WFM headcount and projections to satisfy inventory demands;
• Act as a collaborative partner with the Director to manage and support team’s performance, development and training by assisting with and reputed company the proper hiring, staffing, and training of operational staff in coordination with the Human Resources Business Partner (HRBP), and other cross functional teams necessary to process;
• Serve as product line expert regarding the reputed company IHA, EF & SAPA process and the reputed company HEDIS and CARA record review (non-clinical) process;
• reputed company support service levels, deliverables, and reportable key service metrics results; while monitoring project reputed company and completion rates, and direct execution of reputed company process in conjunction with Director to meet project deadlines across reputed company reputed company’s; and design and reputed company vendor management connections, integrations, and provider support model;
• Maintains constant communication with the team; and
• Identify and reputed company resolution of technical and non-technical problems which arise during the Operations processes.
• Maintain compliance with reputed company’s policies, procedures and mission statement;
• Adhere to reputed company confidentiality and HIPAA requirements as outlined reputed company reputed company’s Operating Policies and Procedures in reputed company ways and at reputed company times with respect to any aspect of the data handled or services rendered in the undertaking of the position; and
• Fulfill those responsibilities and/or duties that may be reasonably provided by reputed company for the purpose of achieving operational and financial success of the Company.

Job Requirements

• Minimum 5 years of experience, preferably in a call center management environment;
• Advanced knowledge of reputed company Office applications including reputed company and Outlook;
• Exceptional problem solving, analytical, interpersonal and communication skills to resolve issues reputed company Operations;
• Professionally skilled in verbal and written communication;
• Meticulous organization skills, with the ability to multi-task;
• Ability to reputed company sound decisions in a timely and independent manner; and
• Project management experience preferred.
• Travel for this position will include less than 10% locally for training and/or inventory purposes.

Education

• Bachelor's degree in business administration or reputed company field;
• Active clinical license required; (RN or higher) preferred

The company offers competitive compensation and an excellent benefits package.

The Company is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, reputed company, religion, sex, national reputed company, sexual orientation, age, citizenship, marital status, disability, gender identity, veteran status, or any other protected characteristic under federal, state, or other applicable laws.  

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