Overview
Looking to be part of something more meaningful? At HonorHealth, you'll be part of a team, creating a multi-dimensional care experience for our patients. You'll have opportunities to make a difference. From our Ambassador Movement to our robust training and development programs, you can select where and how you want to make an impact.
HonorHealth offers a diverse benefits portfolio for our full-time and part-time team members designed to help you and your family live your best lives. Visit honorhealth.com/benefits to learn more.
Join us. Let's go beyond expectations and transform healthcare together.
HonorHealth is one of Arizona's largest nonprofit healthcare systems, serving a population of five million people in the greater Phoenix metropolitan area. The comprehensive network encompasses six acute-care hospitals, an extensive medical group with primary, specialty and urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization, community services and more. With nearly 15,000 team members, 3,700 affiliated providers and close to 2,000 volunteers dedicated to providing high quality care, HonorHealth strives to go beyond the expectations of a traditional healthcare system to improve the health and well-being of communities across Arizona. Learn more at HonorHealth.com.
Responsibilities
Job Summary
The Medical Management Program Manager will be responsible for overseeing all the Medical Management programs daily operations and processes to ensure adherence to all NCQA and Medical Management department policies and procedures. The Manager will provide oversight for all PA/UM staff, and Accreditation Specialist in the department. In addition, this role will ensure that all regulatory requirements and timelines are met, identify trends associated with denials, Out of Network services, formulary exceptions, readmissions, high risk patients and preferred provider referral patterns.
- Coordinate, plan, schedule, and attend monthly operations staff meetings and monthly Medical Management Health Plan meetings.
- Supervise daily schedules work hours, volumes, coverage for unexpected resource variations.
- Develop quality audit tools, quality improvement tools; and educational training around process improvement areas.
- Facilitates and promotes a professional, collaborative communication between all Medical Management participants.
- Communicate effectively and professionally using all modalities i.e. technology, written letter, and verbal in a way that is both clear and concise. Collaborate with payors and other TPA, Consultants working with the department.
- Foster effective teamwork and monitor workloads and productivity. Performs evaluations and feedback for staff and works with Director to identify appropriate program enhancements based on evaluations, quality results, and other metrics.
- Has working knowledge of all regulatory medical management requirements for Commercial, Medicare, AHCCCS, and Medicare Advantage
- Demonstrates and maintains oversight of NCQA regulatory requirements and business changes by participating in joint operations meetings and quality improvement activities. Supports and/or participates in the development and maintenance of the Preferred Provider Scorecard and maintains metric tracking and management.
- Performs other duties as assigned.
Qualifications
Education
Associate's Degree in related area (Healthcare Administration, Business, IT or Clinical area) Required
Experience
5 years in healthcare with experience in pre-certification Required
3 years experience in utilization review, medical management Required
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HonorHealth
Nov 18, 2024