The Program Manager works closely with the Director of Medical Review Services and is responsible for overseeing the day-to-day operations of medical review programs and contracts, including ensuring the quality and timeliness of all deliverables. They work with the director to determine tactics for increasing review service business lines, along with actively responding to new opportunities. The Program Manager provides guidance to direct reports and works to identify efficiencies.
DUTIES AND RESPONSIBILITIES:
Manage daily operations of assigned project/contract area, including working with the director to establish and monitor budgets.
Mentor, guide and provide day-to-day supervision of direct reports.
Provide oversight of direct reports and assist with identification of strategies to ensure assigned roles and responsibilities, as described in the corresponding job description, are met.
Comprehend and monitor all contract aspects related to assigned task(s), including deliverable schedule and metrics, keeping the director informed of potential risks.
Ensure all contract activities are delivered in accordance with quality, performance, timeliness, and financial metrics working with team members to mitigate barriers.
Complete tasks as designated by the director.
Delegate activities according to job and skill levels.
Actively partake in identifying and securing new business opportunities.
Coach, facilitate and implement methods aimed at creating a high-functioning integrative team.
Apply quality principles knowledge, acquired clinical/technical expertise and medical review experience to employ strategies to support attainment of contract goals.
Initiate development of job aids and standard operating procedures.
Proactively identify challenges and deploy mitigation strategies.
Model accountability for self-learning activities as well as the sharing and transfer of knowledge.
Attend and/or presents at local, state or national conferences/meetings, as appropriate.
Develop external relationships and maintain customer satisfaction.
Adhere to all relevant compliance regulations (HIPAA, FISMA, URAC, CMS).
EDUCATION AND/OR EXPERIENCE:
Bachelor’s degree in nursing. Master’s degree preferred
Active nursing licensure in any state
Minimum of 3 years of clinical or related healthcare experience required
Minimum 1-year management experience required
Extensive medical review experience required, Workers Compensation, Utilization Management, Claims Review, External and Quality Review experience preferred
Minimum of 2 years of quality improvement experience required
Ability to read and interpret federal/state contracts and regulations
Excellent written and verbal communication skills required
Exceptional organizational, project management and customer service skills required
Experience with written and electronic documentation review
Ability to multi-task working on more than one contract/project simultaneously
Excellent customer service skills required
Proficient in Milliman and/or InterQual systems
Ability to travel, both in and out of state
Ability and willingness to work off hours, weekends and holidays as needed to ensure deadlines and deliverables are met
Internal Number: -
MPRO is Michigan’s designated Quality Improvement Organization. As a nonprofit organization, we have more than 35 years’ experience improving healthcare across the continuum of care using evidence-based and data-driven logic. We also have extensive experience completing thoughtful and impartial utilization review, dispute resolution and peer reviews.
Our multidisciplinary staff is composed of physicians, registered nurses, data analysts, quality consultants and health information technology experts. Our reach extends throughout the country.
Since 2002, MPRO has maintained URAC accreditation as an Independent Review Organization and in Health Utilization Management. MPRO is a Michigan Health and Hospital Association Endorsed Business Partner.