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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview

The Senior Manager, Eligibility & Encounters needs a thorough technical background combined with outstanding managerial and leadership talents. In addition, the Manager must have in-depth understanding of all managed care systems. They must have strong oral and written communication skills, project management experience, and proven abilities to facilitate multidisciplinary project teams in accomplishing strategic goals.

Typical duties include:

• Assuming overall management and responsibilities for all aspect of

managed care operations and its staff;

• Maintaining and supporting the company's managed care system and

applications;

• Planning, coordinating, and monitoring the progress to ensure their ongoing alignment with business goals;

• Serving as liaison to management, reporting on the status of current projects, identifying issues and assessing their impact, and proactively recommending solutions. Managing relations with and serving as liaison to vendors and external partners with respect to business operations and systems configuration.

Locations

Stanford Health Care

What you will do

• Executes world class practices of service and patient care in support of C-I-CARE standards.

• Uses C-I-CARE templates and the following components for all communication with patients and staff:

• CONNECT with people by calling them their proper name, or the name they prefer (Mr., Ms., Dr.)

• INTRODUCE yourself and your role

• COMMUNICATE what you are going to do, how long it will take, and how it will impact the patient

• ASK permission before entering a room, examining a patient or undertaking an activity

• RESPOND to patient’s questions or requests promptly; anticipate patient needs

• EXIT courteously with an explanation of what will come next

• Manages the performance and functions of the Analysts who are responsible for production support. This entails planning, reviewing, and controlling projects and tasks to ensure seamless integration to existing application infrastructure.

• Serve as liaison between non-technical business units; communicating technical information and plans.

• Work with vendors and internal staff on service issues, and projects to ensure ongoing alignment with department goals and objectives.

• Manage the production and testing aspects of data systems and monitor their effectiveness in meeting business unit needs.

• Assist in establishing and monitoring department quality objectives, milestones and benchmarks. Develop and implement effective tools to measure performance against these standards, and to document and regularly report on all plans, priorities, schedules, budgets, staff assignments, programs and the current status of projects and routine assignments.

• Recruit, train, motivate, evaluate, and retain staff. Plan and manage the development and delivery of training and educational programs for direct reports.

• Ensure all regulatory compliance and delegated health plan requirements within the information systems domain are met. Lead the development and maintenance of policies and procedures that meet tactical and regulatory requirements for the department.

• Contributes to, and manages the change management process

• Performs other duties as assigned, participates in organization projects as assigned and maintains a level of professionalism

• Adheres to safety, P4P's (if applicable), HIPAA and compliance policies.

Education Qualifications

• Bachelor's Degree in Computer Science or equivalent experience Required

Experience Qualifications

• Five plus (5+) years of progressive managerial experience in operations with focus on tactical planning and daily operations Required

• Minimum eight (8) to twelve (12) years experience within a health care organization required; experience with health plan operations in the area of information technology, customer service and/or claims preferred.

• Proven skills in leadership and project management, including managing/developing staff, promoting teamwork, and encouraging innovative ideas Required

• Proven skills in working with business stakeholders to define application strategies, roadmaps Required

• Proficient knowledge in managed care systems and operations Required

• Experience in business analysis or healthcare analysis with experience validating and auditing data and data sets Required

Required Knowledge, Skills and Abilities

• High level of verbal and written communication skills with a strong capacity for detail, maintaining clear/effective contact with physicians, employees, administration and corporate personnel.

• Strong organizational and planning skills to manage multiple priorities and meet required deadlines.

• Strong analytical, critical thinking and problem solving skills to ensure process improvement and projects are completed successfully.

• Proficient computer skills to include Microsoft Office (Word, Excel, and PowerPoint).

• Strong interpersonal skills necessary in order develop and maintain collaborative relationships with staff and physicians.

• Management skills necessary to attract and maintain a highly effective and motivated staff.

• Proven ability to work independently to produce accurate work of the highest quality.

• Manages relationships relevant to projects and requires the ability to gain cooperation of others.

• Knowledge of Managed Care and Health Plan operations, especially around eligibility management and claims administration. Familiarity with the Medicare reimbursement guidelines.

• Significant experience and expert knowledge of medical claims processing information systems.

• Skill and ability to translate concepts into well defined, documented technical requirement and present them to senior leadership.

• Manage work intake, prioritization, assignment and maintenance of data and integration processes and applications

• Ensure development, documentation, and communication of progress reports pertaining to operational and configuration tasks

• Perform team administrative duties including status reporting, team development, self/peer/project assessment

• Carry out personnel management activities including performance management and career development.

• Collaborate with Management peers to facilitate alignment of organizational business and information technology strategies and plans

• Maintain leadership role in setting service direction and ensure standards and policies are maintained and compatible with SHC standards

• Ensure appropriate level of support for ongoing performance of operations, configuration, and application support

• Knowledge of continuous quality improvement techniques

• Ability to manage projects, provide leadership, facilitate meetings, and make presentations before groups of management and staff

• Advanced analytical skills and problem solving skills with the ability to formulate and communicate recommendations for improvement

• Ability to work with ambiguous or unclear requirements, and drive to a successful resolution

• Knowledge and application of English grammar including composition, editing and proofreading skills

• Ability to analyze, evaluate and clearly present written information and findings

• Ability to clearly and concisely communicate financial concepts and technical financial information to management staff

• Ability to interact well with co-workers and outside contacts

Physical Demands and Work Conditions

Physical Demands

• Constant Sitting.

• Frequent Walking.

• Occasional Standing.

• Occasional Bending.

• Occasional Squatting.

• Occasional Climbing.

• Occasional Kneeling.

• Seldom Crawling.

• Constant Hand Use.

• Constant Repetitive Motion Hand Use.

• Frequent Grasping.

• Occasional Fine Manipulation.

• Frequent Pushing and Pulling.

• Occasional Reaching (above shoulder level).

• Constant Vision (Color, Peripheral, Distance, Focus).

Lifting

• Frequent lifting of 0 - 10 lbs.

• Occasional lifting of 11 - 20 lbs.

• Seldom lifting of 21 - 30 lbs.

• Seldom lifting of 31 - 40 lbs.

• Seldom lifting of 40+ lbs.

Carrying

• Frequent lifting of 0 - 10 lbs.

• Occasional lifting of 11 - 20 lbs.

• Seldom lifting of 21 - 30 lbs.

• Seldom lifting of 31 - 40 lbs.

• Seldom lifting of 40+ lbs.

Working Environment

• Occasional Driving cars, trucks, forklifts and other equipment.

• Constant Working around equipment and machinery.

• Seldom Walking on uneven ground.

• Seldom Exposure to excessive noise.

• Seldom Exposure to extremes in temperature, humidity or wetness.

• Seldom Exposure to dust, gas, fumes or chemicals.

• Seldom Working at heights.

• Seldom Operation of foot controls or repetitive foot movement.

• Seldom Use of special visual or auditory protective equipment.

• Seldom Use of respirator.

• Seldom Working with biohazards such as blood borne pathogens, hospital waste, etc..

Blood Borne Pathogens

• Category III - Tasks that involve NO exposure to blood, body fluids or tissues, and Category I tasks that are not a condition of employment

Travel Requirements

• 10% travel:

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care

• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $66.46 - $88.05 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

At Stanford Health Care, we seek to provide patients with the very best in diagnosis and treatment, with outstanding quality, compassion and coordination. With an unmatched track record of scientific discovery, technological innovation and translational medicine, Stanford Medicine physicians are pioneering leading edge therapies today that will change the way health care is delivered tomorrow.

As part of our spirit of discovery, we also leverage our deep relationships with luminary Silicon Valley companies to develop new ways to deliver preeminent patient care.

Learn about our awards (https://stanfordhealthcare.org/about-us/awards.html) and significant events (https://stanfordhealthcare.org/about-us/our-history.html) .