Plans, develops and manages the participating provider network. Develops and implements a provider quality management program that includes delegation of credentialing and recredentialing and feedback to the provider network on issues related to utilization and quality. Undertakes provider education in relationship to managed care, resolves inquiries and concerns.
Responsibility: Actively supports and advances the Quality Work Plan for improving performance in department/unit and programs for purposes of making ACH better.
- Develops quality improvement processes that include goals and performance targets.
- Plans, implements and evaluates specific improvement activities.
- Obtains and uses data to drive and support quality improvement initiatives.
- Communicates the quality work plan to staff and incorporates changes to support the effectiveness of the plan.
- Leads and supports ongoing activities that promote safe practices and a safe environment.
- Promotes the use of Safety Tracker and internal reporting tools for proper recording of safety issues.
- Manages staff compliance with requirements for CMS, Joint Commission and other regulatory bodies.
- Monitors proper documentation for meeting regulatory compliance standards related CMS, Joint Commission and other regulatory bodies.
- Uses information gathered from staff reporting to help guide, direct and revise improvement activities.
- Holds self and staff accountable for assigned duties as reflected in performance evaluation processes.
- Holds staff accountable for compliance with safety practices, policies and regulations.
- Deliberately incorporates front-line staff into existing groups and meetings to engage all levels of staff in improvement activities.
- Supports and allocates time/resources for the development of staff in building competence in improvement activities.
- Participates in advanced leadership development and training in quality improvement processes.
Responsibility: Talent Management - Building Effective Teams by attracting highly skilled workers, integrate new staff to their jobs and into the organization, and develops and retains skilled workers to meet current and future business objectives.
- Coordinates a hiring and selection process that is fair and equitable in its evaluation and placement of the most qualified individuals for meeting job-specific and departmental needs.
- Recognizes talent and hires the best people from inside or outside of ACH;
- Follows fair and equitable hiring and selection processes in accordance with ACH policy and procedures.
- Maximizes resources to provide employees with tools, resources and an environment to succeed.
- Creates a climate in which people feel valued and want to do their best;
- Engages direct reports, team or project members in work/projects;
- Provides timely information people need to know to do their jobs;
- Fosters shared-decision making;
- Assigns responsibility for tasks and decisions with clear objectives and measures;
- Distributes workload appropriately and holds staff accountable for performance standards.
- Maintains two-way dialogue with others on work and results
- Treats direct reports equitably; acts fairly;
- Speaks openly and honestly;
- Accepts feedback openly and takes responsibility for own actions;
- Addresses problems timely and provides "actionable" positive and corrective feedback to others;
- Takes corrective action when necessary;
- Implements development plans for employees that will strengthen current and future capabilities and enable them to contribute fully in their job role and the organization.
- Engages in coaching and mentoring techniques for successful succession planning;
- Provides challenging and stretching tasks and assignments to staff;
- Assesses individual challenges and deficits while encouraging staff to accept developmental opportunities;
- Assist staff in constructing development paths based on individual career goals.
Responsibility: Fiscal Management and Resource Utilization
- Prepares, justifies and administers departmental and program budgets
- Understands the hospital's financial processes;
- Manages department/program financial processes to ensure alignment with strategic goals;
- Takes ownership of key planning, budgeting and forecasting processes for areas of responsibility;
- Monitors financial performance through key indicators;
- Succeeds in achieving maximum results with budgeted resources;
- Maximizes and manages allocated resources to achieve desired departmental and program results (staffing, space, equipment and supplies).
- Develops and implements systems, procedures and processes in order to improve financial management in areas of responsibility;
- Prioritizes resource utilization against key indicators and operational needs;
- Uses cost-benefit and value thinking to set or change priorities;
- Holds self and others accountable for operating within annual budgets;
- Engages staff in efficient utilization of resources and reduction of waste.
- Leads strategies to improve financial performance for assigned areas and hospital, including expenses, revenue and productivity.
- Instills financial management accountability through better accounting of assets and liabilities, accurate tracking of expenses and revenue;
- Implements strong controls to mitigate waste, fraud, and abuse;
- Drives improved quality through improved efficiency at lower costs;
- Promotes innovations to preserve or extend the life span of products or processes;
- Identifies and implements other avenues to achieve financial savings and improved service delivery, including initiating changes in processes and programs that are not functioning to the highest capacity.
Physician/Provider Relations Management
- Develops and implements strategic and long range plans for the growth and maintenance of the provider network
including network geographic coverage.
- Acts as liaison to providers including managed care contracts as well as
representing provider concerns in advanced managed care situations.
- Facilitates provider education related to
- Develops positive working relationships with providers
- Develops and oversees managed care credentialing process. Is responsible for integrity of data and information regarding the provider network.
- Maintains thorough knowledge of managed care
standards related to credentialing.
- Undertakes and manages delegated credentialing function in managed care contracts when applicable
Maintains CHCS communications as a messenger and responsible for payer reporting
- Messengers CHCS contracts as appropriate.
- Provides accurate and timely information to the provider network
regarding CHCS contracts.
- Identifies the provider network composition for each contract and reports to payers at time of contract inception and least quarterly thereafter.
- Maintains positive relationships with payers and facilitates provider
entry into payer networks
- Is responsible for managing the Utilization and Quality Management Committee (U&QM).
- Works with the Committee
chairperson, the ACH Director of Quality Improvement, the Vice President for Ambulatory Care Services and others on
opportunities to improve quality and service to the provider network and the referring community.
recommendations of the U&QM Committee to the CHCS Board of Directors
Bachelor's degree from four-year college or university
• Field of Study: general Note: Undergraduate degree in healthcare or management field desired
• Experience Substitution: Or four years related experience and/or training; or equivalent combination of education and experience.
5 years total experience required
which includes 5 years of managed
care/health insurance or medical billing/coding experience
• which includes 5 years of management experience
Physical Activity - Stand
Physical Activity - Walk
Physical Activity - Sit
Physical Activity - Use hands to touch, handle, or feel
Physical Activity - Talk or hear
Lifting/Pushing/Pulling Weight - Up to 10 pounds
Noise Level - In general, the noise level for this position is considered to be:
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