Practice Manager
GN Group
Manager, Business Standards, Oversight
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Remote • Kansas, Montana, New York, Tennessee • 🇺🇸 United States
Visit company websiteSalary
💰 $86,000 - $154,700 per year
Job Level
Mid-LevelSenior
About the role
- Provides regulatory and contractually required document management oversight the Utilization Management, Care Management, and/or Appeals leadership along with Compliance Officers regarding the requirements of accrediting and regulatory agencies
- Oversees the team of associates who create and maintain documentation in direct support of regulatory and accreditation requirements
- Develop and oversee quality review and adherence to performance of timely documentation development, performance in internal and external audits, and support within the operational areas of PHCO
- Maintain oversight monitoring of surveillance and defect reports, continual audit readiness, and drive responses to remediation plans impacting the areas supported
- Provide direct support to the operational teams within PHCO for new business readiness, integrations, large scale implementations, and internal and external audits with the timely delivery of high quality documentation and supportive needs
- Align and identify changes needed to strategic initiative planning alongside senior leadership to align with budgetary capabilities and supporting the needs of PHCO
- Ensures all operational processes are compliant with NCQA standards, as well as state and federal contract guidelines for documentation in policy
- Coordinates with Regulatory Affairs in each line of business to ensure that corporate policy and addendum's are compliant
- Coordinates with the Training team to ensure that training curriculum supports operational processes as defined in policies and procedures
- Coordinates schedules for review and revision of policies and procedures
- Supports the remediation and operational departmental responses to individual market EQRO/State and CMS audits
- Leads preparation of files for respective external audits
- Provides feedback to leadership team regarding audit results, opportunities for improvement, and/or required Corrective Action Plans
- Provides Compliance team performance reports to appropriate leadership representatives
- Performs special projects as assigned
- Performs other duties as assigned
- Complies with all policies and standards
Requirements
- Bachelor's Degree in Health Care related field, or related work experience required
- 5+ years of regulatory, audit, oversight or healthcare delivery required
- Previous lead experience including, but not limited to, responsibilities for hiring, training, assigning work and managing performance of staff required
- Clinical licensure preferred and required if role charged with policy management
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
document managementquality reviewaudit readinessremediation planspolicy managementperformance reportingcompliance oversighttraining curriculum developmentstrategic initiative planninghealthcare delivery
Soft skills
leadershipteam managementcommunicationorganizational skillsproblem-solvingcollaborationfeedback provisionadaptabilityattention to detailproject management
Certifications
Bachelor's Degree in Health CareClinical licensure
