If you're seeking to work for one of the nation's most respected providers of health care administration, look no further! Vestica Healthcare is looking for a self-starting individual to serve as a Director of Medical Administration. If you are looking for a fast paced, technology-focused, and high-energy work environment where you can make a difference, apply now! Responsibilities may include but are not limited to:
Essential Job Responsibilities:
- Oversee Utilization Management and Reimbursement departments within the organization. Specifically focus on ensuring the company is adhering to regulatory and client requirements as it pertains to benefit payment, case management and disease management.
- Collaborate with Chief Operating Officer on different strategic initiatives to better align the departments for meeting organizational goals and objectives.
- Utilize statistical techniques to analyze various sources of data to develop and maintain key performance metrics, evaluate trends, and to manage staff to appropriate metrics to drive behaviors.
- Apply concepts and tools of the medical/managed care industry to fully understand and manage benefit cost structure across client markets.
- Identify, develop and implement best practices to ensure improved efficiency, cost effectiveness, and contractual requirements are met and/or exceeded.
- Foster an environment of continuous improvement though process and systematic efficiencies.
- Work in conjunction with Human Resources to evaluate viable candidates under consideration for hire by identifying necessary skills and core competencies for various roles, developing relevant interview questions to assess candidate knowledge, skill, and position fit with future growth and business objectives, and utilizing appropriate selection techniques.
- Develop, and motivate staff. Initiate and communicate a variety of personnel actions including employment, termination, performance reviews, salary reviews, disciplinary actions, and development plans. Provide regular and behaviorally specific feedback to increase performance levels.
- Interpret and communicate accurate benefit information to staff by having a comprehensive understanding of benefits for multiple markets.
- Act as primary contact for Reimbursement and Utilization Management during new customer on-boarding and provide direction to staff to ensure understanding and ability to service new clients accurately.
- Develop and maintain client relationships by interacting directly with clients on escalated issues and providing feedback and communication as appropriate.
- Ensure departments are meeting appropriate quality standards through audits, appropriate controls, and review of practices and outcomes.
- Ensure staff is providing accurate and timely service to Members and Providers that contact them directly with questions and direct others to appropriate areas in the organization when unable to assist.
- Work closely with management team to develop and implement appropriate training methods to ensure staff is provided with the appropriate tools to meet client requirements and objectives.
- Work effectively and collaboratively with peers and other internal resources in diagnosing and resolving issues.
- Regularly work with management staff to evaluate policies and procedures and facilitate the development and implementation of new efficiencies based on assessments.
- Update Chief Operations Officer on any significant issues in relation to clients and providers.
- Acts as expert in the areas of Utilization Management and Reimbursement and aid in answering Request for Proposal (RFP) questions regarding any of these areas.
- Foster an environment that focuses on ensuring integrity, respect, accountability, and superior service.
Why work here?
We are not complacent. Our culture is one where innovation is the goal, hard work is expected, and creativity is rewarded. Vestica Healthcare employees enjoy competitive salaries, excellent health benefits, and a network of like-minded co-workers that drive innovation across the entire healthcare technology industry. Our culture is one of:
- Mutual respect
At Vestica Healthcare and our family of companies you will have opportunities to work with people who are as passionate as they are talented, develop yourself and your skills, and create valuable relationships every day. Our goal is to transform the insurance administration process by making it as efficient and automated as possible. We are constantly on the lookout for brilliant employees with an entrepreneurial spirit who are hard working, focused, and have a passion for innovation.
Vestica Healthcare is an Equal Opportunity Employer. Vestica shall, in all solicitations or advertisements for employees placed by or on behalf of Vestica, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, age (except as provided by law), marital status, political affiliation, or handicap, except where it relates to bona fide occupational qualification.
- Required Level of Education, Licenses, and/or Certificates
- Bachelor’s degree in Business, Health Care or other related field is required.
- Required Level of Experience
- 5 - 7 years of experience in a managed care environment.
- 5 - 7 years of management experience.
- Required Knowledge, Skills, and Abilities
- Extensive knowledge of the Medicare and/or Medicaid program, particularly the coverage and payment rules.
- Knowledge of medical procedures, terminology, and coding.
- Excellent oral and written communication skills.
- Ability to manage multiple priorities and remain organized with multiple interruptions.
- Demonstrated ability to improve processes by creating efficiencies and/or saving money.
- Ability to successfully lead teams.
- Demonstrated skill in utilizing data to drive decisions and behaviors.
- Demonstrated use of Microsoft Office products (Word, Excel, Powerpoint).
- Preferred Level of Education, License, and/or Certificates
- Master’s degree in Healthcare Administration or MBA.
- Preferred Level of Experience
- Previous experience managing multiple departments.
- Claims payment experience.
- Preferred Knowledge, Skills, and Abilities
- Knowledge of common risk management practices associated with waste and abuse.
- Knowledge of Enterprise System