Operations Director for Clinical Ops (Utilization Management) Manage activities of a department including, but not limited to, planning, problem solving, staff development, and communication related to accounts assigned and project management Manage relationship with client Review and analysis of periodic reports and metrics Executes function/area objectives that support continuous improvement and Evaluation of operational practices and procedures Support internal audits, ensuring compliance parameters are met Responsible for special projects and resolution of issues Actively provides inputs and assistance to the senior management in the planning, implementation, and evaluation/ modifications to existing operations, systems, and procedures, specifically relating to his/her assigned project(s) Responsible for managing attrition and building retention strategies Provide regular performance feedback and giving frequent formal and informal coaching sessions Provide support to quality initiatives targeted towards process improvements Accountable for daily/weekly performance updates to key stakeholders Provide effective and efficient solutions to complex business problems. Provide direction to staff, ensure resolution of problems; sets priorities Provide high level oversight and leadership. Responsible for balancing workload to optimize the effectiveness of the department. Work with Finance and Operations on monthly invoicing tasks DIRECTION EXERCISED: Responsibilities include, but are not limited to, effectively interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. QUALIFICATIONS: EDUCATION: Bachelor's Degree holder preferably in the field of Nursing, Healthcare or Allied Medical Profession Credential/Professional Certification related to current work an advantage (Coding License) or USRN Lean Training and Certification an advantage EXPERIENCE: Should have overall 10+ years with a minimum of 3 years in the role of Manager/ Deputy Manager in a BPO setting with knowledge on Appeals and Grievances, Medical Coding, Abstractions (HEDIS and/or Clinical Abstractions), and Utilization Management Should have the ability to effectively handle large teams in a fast-moving business environment Should have the ability to supervise and manage a team of frontline supervisors Should have knowledge of organizational structure, workflow, operating procedures, and transition management SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: Proficient knowledge on Utilization Management Strong proficiency in Windows OS and Microsoft Office applications Should possess the skill to examine and re-engineer operations and procedures Ability to develop comprehensive planning and project management Should be able to work in a fast-paced environment with multiple transitions in progress Ability to work under general direction and work effectively in a team environment Excellent analytical, organizational, planning, verbal, and written communication skills Ability to work with and empower others on a collaborative basis to ensure success of unit team Ability to effectively present budgetary and/or cost information and respond to questions as appropriate Ability to establish workflows, manage multiple projects, and meet necessary deadlines Your application will include the following questions: How much notice are you required to give your current employer?
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