
Manager- Quality Field Operations- Remote - Field Based New England
- Boston, MA
- $89,900-160,600 per year
- Permanent
- Full-time
- Sets team direction, resolves problems, and provides guidance to members of the team
- Ensures team meets established performance metrics, performance guarantees, and quality standards
- Manages administrative and clinical operations consisting of field based and/or contact center-based staff
- Manage relationships with physician practices
- Manage implementation of new physician practices and deployment of resources
- Manage client relationships
- Collaborate with cross functional teams on practice specific strategies to improve Medicare Stars ratings
- Takes the lead role in setting direction and participating in or developing new programs
- Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff
- Work most often impacts a large business unit, or multiple markets/sites, or at the segment/market group level for functional staff positions
- Drives performance through audits and coaching to team personnel to ensure products and services fully meet the client expectations while maintaining efficient and profitable operational delivery
- Assure the onboarding and training of new and existing staff to support product growth and service enhancement
- Fiscal and operational discipline and management
- Weekly commitment of 60% travel for business meetings (including client/health plan partners and provider meetings) and 40% remote work
- 5+ years of Medical / Healthcare industry experience
- Knowledge of Benefits and Claims Systems and Operations
- Proven solid inbound and outbound telephonic skills
- Proven teambuilding and leadership skills
- Proven effective skills in motivating and mentoring others
- Proven excellent communication and presentation skills
- Proven computer skills and technical aptitude, familiar with MS Office
- Demonstrated ability to identify with a consumer to understand and align with their needs and realities
- Demonstrated ability to perform effective active listening skills to empathize with the customer to develop a trust and respect
- Demonstrated ability to take responsibility and internally driven to accomplish goals and recognize what needs to be done to achieve a goal(s)
- Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer
- Weekly commitment of 60% travel for business meetings (including client/health plan partners and provider meetings) and 40% remote work
- Customer service management experience
- Medicare Stars experience
- HEDIS experience
- Project management experience
- Quality or Six Sigma experience
- Experience in utilization review, concurrent review and/or risk management
- Proven Project/Product coordination/management skills
- Proven background in managed care
- Proven solid organizational skills and multitasking abilities will be keys to success