Manager Provider Operations

Job Overview:

As Manager of Provider Operations, managed the team responsible for identifying, scheduling and processing medical consults and other outside medical services (lab, radiology), in-house medical specialty services as well as other PACE services that the Project Specialists are responsible for auctioning. Ensures workflows are maximally efficient. Tracks and reports compliance with scheduling and receipt and review of consult reports. Maintains active relationships with medical providers. Identifies network gaps and works collaboratively with Provider Relations to address.

Responsibilities:

Provider Operations activities include:

1. Direct and supervise project specialists in creating authorizations, scheduling appointments and receiving/processing consult reports, ensuring optimal operational efficiency and cross-coverage when needed
2. Ensure staff are maximally using EMR to drive daily work
3. Track and report compliance with regulations as it relates to appointment scheduling and receipt and review of medical consults, as well as reporting compliance with other PACE services (such as laboratory) to ensure compliance
4. Leveraging the EMR to identify, action and track compliance to the greatest extent possible
5. Troubleshoot to solve issues impacting operations and compliance
6. Maintain active relationships with medical providers through regular outreach, which can include visits to provider offices and phone communication.
7. Identify need for and acts on feedback from project specialists regarding needed outreach and education with specific providers to ensure appointments can be secured and consult reports are provided.
8. Identify network gaps and works collaboratively with Provider Relations to address.
9. Oversee and manage SCA process to ensure requests are submitted complete and timely, and are followed through to completion timely
10. Ensure project specialist tasks are covered during PTO, LOA, etc. and perform project specialist tasks as needed
11. Other duties as assigned

Other activities include:

1. Develop and oversee process to record vaccinations with various NYC and NYS-required registries
2. Conduct regular audits of DTCs to ensure regulatory compliance
3. Develop and implement par levels for DTC supplies
4. Participate in compliance audit and other compliance activities as requested
5. Compile and track data as requested by senior leadership
6. Other duties as assigned

Requirements:

• Bachelor’s Degree required
• At least 2 years relevant experience in health care operations, managed care or provider relations or related field involving workflow creation and execution, managing and reporting data and performing customer service functions
• Supervisory experience preferred
• Proficiency in Microsoft Excel required
• Weekly travel to PACE sites required