Manager-Utilization Management, Compliance and Shared Services
Responsible for leading, coaching, directing, and assuming responsibilities for the day-to-day functions of the Health Care Management’s Training and Compliance department; coordinate and monitor all department and cross functional team activities to support critical engagement activities and ensure adequate staffing and service levels; responsible for the selection, training and development of personnel; monitor performance of direct report team members; act as an information and problem solving resource for direct report team members and all departments in Health Care Management; support department efforts in developing solutions to ensure goals and objectives are met in a timely fashion; provide program reports for leadership and peers; ensure all regulatory and accreditation standards under CMS and NCQA are continuously achieved by all departments under Health Care Management for Commercial, Medicare, and Medicaid plans, including compliance oversight of both network and vendor delegates, ongoing review of standards and conducting audits; ensure all regulatory and accreditation elements of the CMS Managed Care Manuals are implemented in all Health Care Management departments, including the development or revision of policies and procedures, forms, letters and scripts to ensure compliance with the CMS Managed Care Manuals; utilize knowledge of and experience with CMS and NCQA regulatory and accreditation standards, CMS and NCQA compliance audits, clinical nursing, SharePoint, and Managed Care principles and program planning/implementation to perform duties; ensure on-going adherence to the Managed Care Manuals through consistent monitoring and education of Health Care Management’s clinical and support staff; provide oversight for developing and conducting on-going audits of all Health Care Management departments that are evaluated in CMS or NCQA compliance audits; coordinate with other leaders with the HCM group as well as other IT and business leaders to ensure holistic application solution designs meet HCM business needs; provide optimum end user efficiency and accuracy; and support testing and configuration for all HCM software programs.
Minimum Qualifications:
Education: Bachelor’s Degree in Nursing, Healthcare Management, or in a related field of study (will accept equivalent foreign degree);
Experience: Three (3) years in the position above, as a RN Lead Project Coordinator, as an Advanced Medicine RN – Catastrophic Care, as a Nurse Associate II RN, as an OR Registered Nurse, as a Registered Nurse, or in a related occupation;
Will accept five (5) years in the position above, as a RN Lead Project Coordinator, as an Advanced Medicine RN – Catastrophic Care, as a Nurse Associate II RN, as an OR Registered Nurse, as a Registered Nurse, or in a related occupation, in lieu of primary education and work experience requirements.
Other Requirements: Must have one (1) year experience with all the following: CMS and NCQA regulatory and accreditation standards; CMS and NCQA compliance audits; clinical nursing experience; SharePoint; Managed Care principles and program planning/implementation.
Will also accept any suitable combination of education, training and/or experience.
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health care systems, is a national leader in clinical care, research and education. The system includes the 1,200-member Henry Ford Medical Group, five hospitals, Health Alliance Plan (a health insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory network and many other health-related entities throughout southeast Michigan, providing a full continuum of care. In 2015, Henry Ford provided $299 million in uncompensated care. The health system also is a major economic driver in Michigan and employs more than 24,600 employees. Henry Ford is a 2011 Malcolm Baldrige National Quality Award recipient. The health system is led by President and CEO Wright Lassiter III. To learn more, visit henryford.com
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. My Choice Rewards is a program as diverse as the people it serves. There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.