Job Description
Summary
Under the direct supervision of the Senior Medical Director of Operations, the Medical Director Project Manager of Operations, will be responsible for overseeing and managing key projects within the Managed Services Organization (MSO) that align with the clinical and operational goals. This role will bridge the gap between medical management and operational efficiency, ensuring that projects related to quality improve horizontal integration with UM with all other core teams in MPM are executed effectively. They will collaborate with senior leadership, clinical teams, and operational departments to drive initiatives that improve patient care, optimize provider performance, and support overall organizational growth.
Duties and Responsibilities:
- Provide operational assistance to ensure quality and efficient production across all aspects of Utilization Management.
- Assist in updating and implementing routine training manuals, including creation and updates.
- Develop educational courses to enhance team knowledge and performance.
- Facilitate cross-training and integration efforts to ensure flexibility and continuity in production.
- Create sub-teams that can adapt to shifting production focuses. For example, nurses who can assist with letter writing.
- Identify vulnerable knowledge areas and develop redundancy strategies, ensuring backup solutions for critical subject matter expertise (e.g., network knowledge, UM Out of Network Contract Liaison).
- Focus on improving denials related to advanced imaging in ED utilization.
- Conduct claims-based reviews and provide support for the implementation of nurse review teams, collaborating with UM leadership and the strategic operations process improvement (SOPI team)
- Identify areas with low denial rates and develop strategies to improve outcomes and capture missed opportunities.
- Identify areas with excessively low or high denial rates and develop strategies to improve outcomes and capture missed opportunities.
- Enhance communication channels across IPA Clients and MedPOINT Management (MPM) to promote collaboration and operational efficiency.
- Improve communication lines between PPG Clients and MedPOINT Management, including working with Precertification’s (back office, authorization coordinators, nursing interface) and ACM teams.
- Support MPM Contracted PPG’s in developing embedded care coordinators or improving existing teams’ communication with MedPOINT’s ACM team.
- Collaborate with MPM PNO and Quality departments to leverage existing relationships, strengthening communication strategies.
- Work to improve relationships with Capitated Hospitals, ensuring efficient coordination and better integration with MedPOINT's management system.
- Complete other tasks as deemed necessary.
Minimum Job Requirements:
- Valid LVN/ RN License
- Experience with managed care organizations. Familiar with complex systems and process improvement.
- 2+ years of project-based and/or administrative experience work experience in the healthcare field.
- Proficiency in medical terminology and coding, with the ability to interpret and apply coding systems such as ICD-10, CPT, and HCPCS for support of clinical review and documentation purposes.
- Demonstrated experience in crafting formal documents and policies; experience in supporting data-driven decision
- Demonstrates strong leadership with the ability to influence, motivate, and engage interdisciplinary team members effectively. The successful manager will persistently drive project progression while maintaining a focus on quality outcomes and cost efficiency.
- Approaches patient and system challenges as opportunities for innovation and growth. This individual thrives in independent, remote work settings and is passionate about creating lasting, positive impacts for the client and organization.
- Has excellent prioritization skills when managing competing demands
- Promotes a multidisciplinary, collaborative approach.
- Possesses strong problem-solving abilities, attention to detail, and ensures consistent operational compliance with state, federal, and accrediting agency standards.
- Proven experience in program implementation in healthcare. The responsibilities include assessing, planning, coordinating, monitoring, and evaluating strategies for each operational project
- Actively participates in operational meetings as delegated by the Senior Medical Director of Operations. Supports operations, compliance efforts, and oversees program performance while serving as the liaison.
Skills and Abilities:
- Proficient in using Microsoft Excel, PowerPoint, and Word; familiarity with EZ-CAP® is advantageous.
- Strong multitasking ability, adept in fast-paced environments, exceptional organizational skills, and time management.
- Experience with managing multiple projects and leading them to completion.
- Excellent written and verbal communication; detail-oriented with a focus on accuracy.
- Handles confidential information with discretion; possesses strong interpersonal skills and a professional demeanor
- Demonstrates adaptability and a proactive approach to problem-solving
- Effective communication across all platforms.
Salary Range:
Job Tags
Contract work, Work experience placement, Shift work,