Manager of Clinical Business Process Monitoring
Company: MetroPlusHealth
Location: New York
Posted on: September 28, 2024
Job Description:
Empower. Unite. Care.MetroPlusHealth is committed to empowering
New Yorkers by uniting communities through care. We believe that
Health care is a right, not a privilege. If you have compassion and
a collaborative spirit, work with us. You can come to work being
proud of what you do every day.About NYC Health +
HospitalsMetroPlusHealth provides the highest quality healthcare
services to residents of Bronx, Brooklyn, Manhattan, Queens and
Staten Island through a comprehensive list of products, including,
but not limited to, New York State Medicaid Managed Care, Medicare,
Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold,
Essential Plan, etc. As a wholly-owned subsidiary of NYC Health +
Hospitals, the largest public health system in the United States,
MetroPlusHealth network includes over 27,000 primary care
providers, specialists and participating clinics. For more than 30
years, MetroPlus has been committed to building strong
relationships with its members and providers to enable New Yorkers
to live their healthiest life.Position Overview The Manager of
Clinical Business Process Monitoring leads monitoring and auditing
activities of clinical business processes for internal and
delegated entities. The Manager of Clinical Business Process
Monitoring oversees the core functions of routine clinical
monitoring and special audit/monitoring projects, the analysis of
findings and presentation of those findings to internal teams and
delegated vendors. In addition, this role provides strategic
proposals and careful planning to meet organizational goals,
minimize regulatory risk and consider efficiencies within vendor
and other special projects as assigned to meet targets and take
measurable steps to achieve successful outcomes.Job Description
Oversees day to day monitoring and
auditing activities of clinical monitoring team.Performs internal
clinical monitoring activities and audits and lead special/ad hoc
projects as assigned by leadership. Plays a critical role in
driving the progress of corrective actions. Upon identification of
non-compliance, provide oversight of corrective actions plans
issued ensuring timely implementation. Provides support to business
areas in conducting a root cause analysis and development of
effective corrective actions, including guidance on methodology,
identification of relevant regulatory requirements and any
regulatory compliance context, and compliance review. Communicates
with compliance functional leaders to monitor, assess and address
vendor performance and key outliers that require immediate
actionable outcomes.Compiles reporting and develop analysis of
compliance dashboards to present to department and division
leadership.Performs data analysis to identify key outliers for
process improvement and determine high risk areas of focus for
further resolution and successful outcomes.Participates in all
regulatory and in-house audits and special projects that present
high-risk areas for the organization.Ensures vendors and special
project post activity and analysis translate to measurable,
successful outcomes and operational excellence across the board
that impacts members, providers, and all internal and external
stakeholders.Provides coverage for any auditor and any aspect of
responsibility (vendor business process monitoring audits,
internal, special projects, new focus, ad hoc project management)
if/when necessary.Contributes to annual work plan aligning with top
regulatory issues/focus and create recommendations using advanced
critical thinking skill set and outside the box train of thought to
mitigate risk.Creates analytical summary output reports for
meaningful and actionable deficiencies and recommendations
cited.Oversees staff of 1 or more to provide necessary leadership,
training, performance evaluation(s), uphold top quality corporate
compliance standards and successful completion of annual work
planAssists Department Director in annual risk assessment and
Compliance Work Plan developmentMinimum Qualifications
Bachelor's degree required (BSN
degree preferred); andNew York State license as a Registered Nurse
with 5-7 years of managed care clinical operations experience, of
which at least 3 years need to be in a supervisory or managerial
position; orNon-Registered Nurse with 10 years of experience in
managed care compliance/clinical operations/ or quality management
auditing. Strong knowledge of utilization review requirements for
Medicaid and Medicare products.Experience with utilization review
requirements for Medicare and Medicaid benefits.Experience in
delegated vendor oversight, corrective action plan implementation,
facilitating and leading cross-functional work groups.New York
State license as Registered Nurse (preferred)Professional
Competencies
Strong Analytical and critical
thinking skills.Strong quantifiable and problem-resolution
skills.Excellent written, oral and presentation skills with the
ability to multitask and effectively prioritize tasks in a
fast-paced environment.Advanced beginner or higher-level
proficiency in Microsoft Suite products: Outlook, MS Teams,
SharePoint, PowerPoint, Power BI, Power Automate, Visio, Word, and
electronic medical record systems.Functional/Technical
skills.#LI-HYBRID Associated topics: aseptic technique, bacteria,
biopharma, diet, food, food scientist, immunohematology, injury,
physiologist, therapy
Keywords: MetroPlusHealth, New York , Manager of Clinical Business Process Monitoring, Executive , New York, New York
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