HYBRID REMOTE Healthcare Process Improvement Manager

This Jobot Job is hosted by: Donna Gawroski-Kusik

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Salary: $90,000 - $95,000 per year

A trailblazing fertility and family-building solutions medical benefits organization with over 25 years of success, has proudly supported over 500,000 families on the path to parenthood. To meet the evolving needs of today’s families, our organization is proud of our long-standing legacy in fertility and family well-being services, expanding offerings from pre-conception and fertility to parenting, healthy aging, and beyond. We have dramatically improved patient experience through a new and cutting-edge digital interface, customized to each patient’s journey, and expanded services designed to support the physical, emotional, and social health and happiness

We are the largest, most experienced fertility benefit management company in the country offering inclusive family-building solutions to employers, health plans and individual patients. From integrated fertility management, including medical treatment, pharmacy, and reproductive genetics, to surrogacy and adoption, our mission is to help build families by providing access to the best network of doctors, technology and emotional support at the lowest cost. Our programs include an integrated medical and pharmaceutical model that is unique to the industry. Its dedicated nurse care managers, all with experience in reproductive endocrinology clinics, guide employees through every step of their fertility journey, and are available 24/7.

• Low-Cost Health insurance thru United Healthcare
• Critical Illness coverage
• Dental Coverage thru Guardian
• Vision Coverage thru Guardian
• 4 weeks paid vacation.
• 9 company paid holidays.
• Always off on your Birthday
• 401K Retirement plan with Company match
• 500K Basic Life insurance coverage
• Short term and long-term care coverage
• Flex spending account
• Health Savings Account

We are hiring a talented Bachelor’s prepared Process Improvement Manager who comes with strong Performance Management and productivity optimization skills, including reporting, analysis and recommendations. A strong technological background interfacing with IT personnel is required.

MUST have working knowledge of current commercial health insurance product options, including HMO, PPO, EPO, high deductible plans, copay/coinsurance variations, and HRA’s/HSA’s. Additionally, must have knowledge of electronic commerce, including EDI submission and payment of provider claims, EDI submission to payers, EFT, transmission of forms, and web portal interface for providers and members. Knowledge of medical coding, including ICD-10, NDC/GPI, CPT/HCPCS.

MUST live within 3 hours of the NYC metro area to be considered.

Under the direction of the Director of Process Improvement, the PI Manager will be responsible for identifying areas for operational improvement, engage and organize cross-departmental stakeholders, implement changes, ensure testing efforts, and monitor process performance.

Recommends and implements initiatives to improve department efficiency, productivity, workflows, and enhance member and provider experience. Also translates business needs into functional specifications.

• Responsible for program development, implementation, and management of process improvement initiatives.
• Oversee and support the execution of identified process improvement opportunities by working closely with cross-functional teams, including but not limited to IT, Service, Clinical, PMO, Client Success, Finance, Specialty Services, Claims, and Analytics.
• Coordinates, directs, and manages the activities of the department and the process improvement process.
• Assesses business and operational needs for opportunities to improve efficiency, productivity, effectiveness, and accuracy.
• Works with the Director of Healthcare Analysis to develop and deploy an organizational strategy to optimize workflows.
• Uses Lean and Six-Sigma methodology to create and maintain a culture of continuous improvement.
• Responsible for the developing and conducting process improvement training within the organization
• Conduct meetings and disseminates communication related to process improvement activities to senior leadership and staff as needed.

KNOWLEDGE, SKILLS AND ABILITIES

Advanced knowledge and experience with Excel, Project and spec software development tools such as JIRA

Knowledge of NCQA Guidelines, URAC Accreditation and Utilization Management desirable.

Experience with pharmacy benefit management, disease management, care management or the pharmaceutical industry desirable.

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