• PM Compliance and Regulatory Initiatives

    Healthfirst (NY)


    Duties//Responsibilities:

    + **Organizes and leads assigned process improvement projects using methods of team building, data gathering and analysis, process mapping, and problem solving**

    + **Works with appropriate stakeholders to develop and document key processes (like what) within DSE**

    + **Manages regular quality assurance audits on audit failures to ensure appropriate resolution has occurred (i.e. Access and Availability, compliance with documented policies and procedures)**

    + **Partners with DSE teams (i.e. Ancillary, Hospital, Physicians, etc.)to coordinate implementation of new contract terms**

    + **Understands underlying system set-up issues and offer recommendations (i.e. Contract loading, provider id set up)**

    + **Establish and maintain excellent working relationships with corporate departments ((i.e. Provider Operations, Regulatory, Compliance, Reimbursement)**

    + **Manages the the integrity of SharePoint and workflows associated with team deliverables**

    + **Responsible for publishing report out of all work tracked assigned section of SharePoint**

    + **Effectively communicate results to key stakeholders**

    + **Creates presentations and presents as needed on issues // projects // audits conducted**

    + **Tracks //Trends unresolved audit findings to reduce exposure to negative external audit findings**

    + **Serves as the SME on process improvement**

    + **Partners with the Directors//Managers in DSE to review quality assurance findings**

    + **Conduct monthly presentations on the units performance and results.**

    + **Management of report requests and tracking of progress and completion dates**

    + **Manages a team of professionals and responsible for supervision, coaching, performance management, and oversight.**

    + **Ad hoc analysis related to explaining root cause drivers**

    + **As determined by the Director of DSE Operational Solutions may be forward facing with providers as needed.**

    + **_Additional duties as assigned._** **_Minimum Qualifications_** **_:_**

    + **_High School Diploma_**

    + **_Managed Care operations; working with various business partners to facilitate resolution (Legal, Regulatory//Compliance, Quality)_**

    + **_Project planning small and large scale initiatives_**

    + **_Familiarity with implementing corrective action plans and recommending approaches on how to improve efficiency in process flows._**

    + **_Great attention to detail_**

    + **_Creating presentations and presenting to management_**

    + **_Managing a team of direct reports_**

    + **_Critical thinking skills_**

    + **_MS Excel, Word, Power Point_**

     

    WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.