Primary Responsibilities:
- Provide leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff
- Develop and execute strategies for a function or discipline that span a large business unit or multiple markets/sites
- Direct others to resolve business problems that affect multiple functions or disciplines
Required Qualifications:
- Medical Science Graduate from recognized University - MBBS
- 12-15 years of experience in managing large scale operations in Clinical or Medical Coding field
- Extensive experience in interactions with Clients/Onshore teams
- Hands-on experience in managing P/L for the Process
- Handled minimum span of 200-400 FTE- s
- Open to Travel
- Flexible to work shifts: 2PM-11PM (US timings)
Preferred Qualifications:
- Certifications in Medical Coding from AAPC or AHIMA (CPC, CIC, COC, CCS, etc.)
Values Based Competencies:
- Model and Ensure Ethical Behavior
- Deliver Value to Customers
- Lead and Develop People
- Lead Change and Innovation
- Communicate Effectively
- Drive Sound, Disciplined Decisions
- Drive High-Quality Execution and Operation Excellence
Functional Competencies:
- Review and Implement Medical and Clinical Protocols for Staff Oversight and Development:
- Leverage clinical acumen to provide guidance to staff (e.g., disease state, health conditions)
- Assist staff in navigating the medical management system (e.g., find resources, answers questions)
- Provide oversight and review of coordination of care (e.g., chronic condition management, utilization management, case management)
- Ensure employees are current with clinical licensure and certifications
- Develop/oversee/deliver operational or technical training
- Plan/Implement/Manage Medical and Clinical Ops Programs
- Develop policies, procedures, and guidelines for medical and clinical operations programs
- Review/approve policy and process changes
- Evaluate regulatory changes and determine steps needed to implement in programs
- Develop medical and clinical operations program goals
- Identify and implement business development opportunities to support growth of medical and clinical operations programs
- Oversee/navigate technology and software applications utilized in the delivery of medical and clinical operations programs
- Oversee management/service delivery systems utilized in member care
- Intervene in resolution of member or employee complaints or issues as necessary-Create and implement a business continuity plan to minimize interruptions to the business
- Ensure Compliance of Medical and Clinical Ops Programs and Services
- Interpret compliance/clinical/medical reports
- Evaluate compliance with Federal, State, and Local regulatory and organizational guidelines
- Evaluate programs and services against accreditation standards
- Evaluate programs and services against contractual requirements
- Oversee ongoing monitoring and internal auditing against relevant guidelines and standards
- Implement process improvement activities to address areas of non-compliance or ensure procedures are followed
- Measure employee/provider performance against internal procedures and protocols
- Ensure team members address gaps in performance against internal procedures and protocols
- Monitor/Evaluate Overall Medical and Clinical Ops Service, Employee Performance
- Develop and communicate performance metrics and expectations
- Direct data collection and measurement of outcomes (e.g., customer surveys)
- Apply metrics to evaluate services, employee performance, and program outcomes
- Read and interpret reports (e.g., performance, service)
- Identify causes of performance deficiencies and determine appropriate follow up actions
- Drive implementation of best practices and standards
- Plan and Manage Medical and Clinical Operations to Ensure Financial Viability
- Develop operational budgets for medical and clinical operations
- Evaluate staffing ratios, stratification of care, overtime, agency usage, or level of position to effectively manage labor expenses
- Read financial reports, identify reasons for financial performance gaps, and identify opportunities for improved financial performance and enhanced return on investment
- Collect and review data to evaluate financial outcomes of programs and services
- Conduct cost/benefit analysis on programs to drive efficiencies
- Conduct competitive analysis and identify opportunities to enhance financial viability
- Propose and obtain approval for capital expenditures for medical and clinical operations
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