What are the responsibilities and job description for the Managed Care Operations Manager position at PATHWAYS HEALTH PARTNERS,?
About the Role:
The Managed Care Operations Manager plays a critical role in overseeing the daily operations of managed care services within our healthcare organization. This position is responsible for ensuring that all managed care programs are executed efficiently and effectively, ultimately leading to improved patient outcomes and satisfaction. The manager will collaborate with various departments to streamline processes, enhance service delivery, and maintain compliance with regulatory standards. Additionally, this role involves analyzing performance metrics and implementing strategies for continuous improvement in managed care operations. The end result is a well-coordinated managed care system that meets the needs of our patients while optimizing resource utilization.
Minimum Qualifications:
- Bachelor's degree in healthcare administration, business administration, or a related field.
- A minimum of 5 years of experience in managed care operations or healthcare management.
- Strong knowledge of healthcare regulations and compliance standards.
Preferred Qualifications:
- Master's degree in healthcare administration or a related field.
- Experience with data analysis and performance improvement methodologies.
- Certification in managed care or healthcare management.
Responsibilities:
- Oversee the daily operations of managed care programs, ensuring compliance with policies and regulations.
- Collaborate with clinical and administrative teams to develop and implement effective care management strategies.
- Analyze performance data to identify areas for improvement and implement corrective actions as needed.
- Facilitate training and development programs for staff to enhance their skills in managed care operations.
- Serve as a liaison between the organization and external stakeholders, including insurance providers and regulatory agencies.
Skills:
The required skills for this role include strong analytical abilities, which are essential for interpreting performance data and identifying trends in managed care operations. Excellent communication skills are necessary for effectively collaborating with various teams and external stakeholders. Leadership skills are crucial for guiding staff and fostering a culture of continuous improvement within the organization. Additionally, proficiency in healthcare regulations ensures that all operations comply with industry standards. Preferred skills, such as experience with data analysis tools, will enhance the manager's ability to drive strategic initiatives and improve overall service delivery.