Integrated Care Programs Manager
Malden, Massachusetts, United States
Oversee 1,500 Medicaid/Medicare United Healthcare Managed Care Plan Members (Senior Care Options)Manage a program of nine Geriatric Support Service Coordinators with a yearly revenue of $1 millionFacilitate appropriate care coordination between GSSCs, Managed Care Organization, hospital clinical andadministrative staffVerify prior authorizations for accurate billing of MCO for HCBS delivered through the MVES networkManage workflow, deadlines, interactions, and management initiatives across the Integrated Care Departmentfor Care Coordination.Supervise, mentor, and motivate direct reports to encourage their professional development while driving ongoing program improvementsMaintain higher level of insight and analysis to scope projects and propose business solutionsNavigate business priorities and objectives by identifying and mitigating plans and learnings to stakeholders’while being an active participant in the development of client business goalsMaintained a 90%-100% compliance with policies and procedures for assigned program.Confirm that GSSC services are delivered in accordance with program contract requirementsAct as a liaison to the Managed Care Organizations on clinical and other issuesAudit case records for quality assurance, accuracy, completeness, and continuity of the consumer’s careDevelop and maintain programmatic reports as requiredEvaluate individual staff performance and encourage staff development through supervision and trainingParticipate in the interviewing, selection process, orientation, and training process for new staff
