Job Description:Manages and is responsible for a specific operations team within the organization to ensure the team is providing superior customer service and are achieving department goals.ScopeManages an operational team to ensure operational processes for multiple products/lines of business.Job Essentials
Manages team of operations supervisors and trainers responsible for claims or customer service. Develops and monitors multimillion dollar administrative budget.
Provides oversight to employment functions including hiring, performance management, constructive discipline and termination. Fosters employee and team morale. Educates, trains, coaches, problem solves and coordinates the ongoing development of skills in supervisors, trainers and team members.
May oversee the management of claims. May include assuring clams are accurately and efficiently paid by performance guarantee and ERISA guidelines. Develops, administers, and reports service quality key indicators in compliance with Operations and government requirements.
May oversee customer service including ensuring questions and problems are resolved efficiently and accurately according to the Superior Service brand. Develops, administers, and reports service quality key indicators in compliance with Operations and government requirements.
Implements and operationalizes new products, new groups, benefit enhancements, and benefit changes. Implements new regulations, requirements and policies correctly.
Works with other departments to implement and operationalize workflows, key contacts, etc. to ensure the delivery of superior service.
Ensures claims and customer service system integrity, coordinates system changes, and upgrades system for improvements.
Develops effective relationships with other departments in order to ensure financial and customer service standards are met and exceeded.
Ensures that Operations is compliant with internal, NCQA and regulatory agency requirements.
10.Develops, reviews, and updates Operations policy manuals, policy updates, training materials / tools, member payment summaries, and other materials.11.Recommends, develops and implements innovative strategies for retention of existing members, addition of new members, containing dental and medical costs, improving efficiency, and customer satisfaction and service.12.Works with Provider Relations, Physicians' offices, employer groups and agents to establish better communication and resolve complex claims issues.Minimum QualificationsBachelor's Degree in a Business or Health Care related field. Degree must be obtained through an accredited institution. Education is verified.
or -
Five years of professional health insurance experience.
and -
Two years of experience in a management/supervisory position working with the administration of managed care products with emphasis on benefit design, systems structures or applications, payment arrangements, claims processing and administration and customer service procedures to obtain a strong knowledge of state and federal regulations, statutes, laws, HIPAA, NCQA and contractual requirements related to managed care.
and -
Demonstrated intermediate knowledge with Facets or similar claims adjudication system.Preferred QualificationsMaster's Degree in a business or healthcare related field.Effective coach and team builder.
and -
Experience in process improvement methodologies to gain operational efficiencies.
and -
Strong organizational, data gathering, and data analysis skills.
and -
Excellent oral, written, and interpersonal communication skills.
and -
Excellent problem solving, negotiation, and process improvement skills.ScopeOversees day-to-day research coordinator and data management activities.Supervises coordinators in on-site monitoring of ongoing studies/projects.Works directly with the Regional Director to ensure Research Institute Strategic plans, regional, site and department goals are met.Manages, maintains and helps to facilitate working relationships with industry client/sponsor/CRO.Aids in recruitment of new sponsors/CROs/studies and maintaining a diverse research portfolio.Develop and execute various recruitment strategies in order to enhance patient enrolment.Serve as an escalation point for data, regulatory, finance and coordinator issues.Ensure that all aspects of GCP are complied with at all times through provision of training at start-up and initiation meetings for clinical trials and on-going SOP developmentOversees site’s adherence to SOPs, Good Clinical Practice, ICH, and FDA regulations.Identifies and tracks trends and opportunities for improvement of clinical trial performance. Develops and maintains dashboards (metrics) of data to track and trend clinical trial activity. Creates custom reports to analyze key data and provide performance reports for Research Institute leadership.Assists in development or maintenance of Research Institute standard operating procedures, workflows and best practices as needed.Proactively identify project specific issues and sets up strategies to handle this efficiently.Key role as team leader in project planning, implementation, problem solving, tracking milestones and deliverables.Provide direction for the technical, protocol-specific and operational aspects of assigned trials; guiding and supporting the project team to ensure adherence with project objectives, timelines and budget.Ensure appropriate development of all documents including but not limited to study documents (e.g. , ICF, Monitoring Plan, Protocol, Communication Plan, etc.) and other project specific documents required to conduct clinical research projectsEnsure study tracking and databases are maintained, updated per site and sponsor requirementsServe as a central point of contact and ensure cross-functional teamwork among clients, internal teams, external team, ancillary services and vendors; collaboration with major functional areas to identify and evaluate fundamental issues on the project, interpret data, make good business decisions and ensure implementation of timely solutions.Preparing comprehensive plans with detailed timelines as dictated by client/sponsor; anticipate and address issues that may otherwise hinder achievement of time-sensitive deliverable; applying data and evidence based decision-making skills.Monitor project schedule and scope to ensure both remain on track. Implement and follow pre-approved procedures for any deviations.Oversee all projects simultaneously, tracking and guiding to complete on time and within budget.(All SCL jobs) Promotes mission, vision, and values of SCL Health, and abides by service behavior standards.(All SCL jobs) Performs other duties as assigned.Minimum QualificationsRequiredBachelor’s degreeResearch certification (either SoCRA, ACRP, or RAC) or completion of certification within 1 year of hire7 years experience in a clinical research setting3 years supervisory/management experienceWorking knowledge of GCP, ICH guidelines and FDA regulationsWorking knowledge of project management, drug development, client/CRO/Sponsor processesExperience with Industry Sponsored, NCI sponsored ,and Investigator Initiated clinical trialsKnowledge of clinical trial fieldwork monitoring concepts and practices including on site monitoring requirements, FDA and IND regulations, and GCPsExperience in Microsoft Office and/or GoogleExcellent oral and written communication skills and strong organizational abilitiesPreferredMaster’s degreeCertified Project Management ProfessionalExperience with electronic medical record systems, clinical trial management systems, and electronic data capture systemsExperience working with physiciansWorking knowledge of Site Investigator Platform (SIP)To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements list must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Excellent organizational skills with a proven history of being able to handle multiple competing priorities at a fast pace with high quality.Accuracy, attention to detail, and ability to set priorities and meet deadlines.Exceptional verbal and written communication skills while providing superior customer service to physicians, sponsors, clinical staff, executives, and internal staff.Regular attendance to perform work on site during regularly scheduled business hours or scheduled shifts is required.Physical Requirements:Location:St. Marys Regional HospitalWork City:Grand JunctionWork State:ColoradoScheduled Weekly Hours:40The hourly range for this position is listed below. Actual hourly rate dependent upon experience.$33.01 - $50.97We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.All positions subject to close without notice.
