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Operations Manager / Vendor Management Medicare amp Medicaid - Work at Home

Company name

Nashville, TN
3 hit(s)  


Operations Manager / Vendor Management (Medicare & Medicaid) - Work at Home','18000856','!*! The Operations Manager Delegated Entities role assists with operations activities for a large region of the organization in compliance with the organization's and government policies. Leveraging CMS compliance and business needs, this candidate reviews operations related to Delegated Entity (DE) systems and procedures, and recommends improvements to increase efficiency. This individual may supervise operations activities within a functional or multi-functional area of the organization.The ideal candidate will ensure manageable span of control, which will allow the business to remediate process and business activities in a proactive, systematic, and controlled fashion that is sustainable rather than reactionary. This candidate will identify barriers and risks, and mitigate in an effort to ensure teams can perform their functions timely and effectively. The Operations Manager will work with business owners to ensure all timing and quality metrics are achieved. This leader will drive continuous improvement through a holistic and well-run inspection/remediation process, and deliver on our mission – to improve the health, well-being and sense of security of the people we serve.Reporting Relationship:The Operations Manager reports to the Director of Operations.Responsibilities:• Ensures all Utilization Management Delegated Entities are selected based on their ability to meet specified requirements including quality, compliance, and business requirements o The need to identify risks and controls during the selection processo Risk identification as high, medium, low during the selection processo Involve business domain experts • Perform Utilization Management Delegated Entity evaluations• Establish Utilization Management Delegated Entity controls• Finalization of contract requirements:o SLAo key measureso oversight timelineso non-conformanceso CAPs• Accountable for the day to day Business Delegated Entity operations• Coordinates work effort with related business streams and management to ensure compliance and quality standards• Ensures Utilization Management DE business processes are consistent with organizational policies and procedures and compliant with state and federal guidelines. • Accountable for maintaining production standards, reporting, systems utilization, training, intradepartmental coordination in an effective and quality manner. • Effects changes that result in increased efficiency and improved quality in collaborative and influential role with matrix partners• Balances multiple team priorities to achieve departmental objectives• Directs the prioritization of activities that support satisfaction, timeliness and quality objectives • Holds business accountable for quality and internal metrics • Provides effective communication to engage and develop cross functional staff in a virtual environment• Effectively communicates to engage and drive desired behaviors within the team• Collaborates with matrix partners to help ensure objectives and standards are met, policies and procedures are followed, gaps identified and closed, communications are clear','!*!Qualifications • Vendor / DE Management within a regulated environment preferred• Quality (LSS) background preferred• Bachelor’s degree preferred• Experience managing a diverse group of functional areas is preferred.• Experience managing in a virtual environment or across multiple locations is preferred.• Proven ability to build relationships and influence strategy with matrix partners.• Business Acumen: Demonstrated excellence in decision making skills, excellent communication, interpersonal and negotiation skills. • Business Application: Ability to initiate research, plan and coordinate and organize.• Able to effectively leverage business and organizational knowledge within and across functions. • Written Communications: Exceptional verbal and written communication skills.• Proven track record of relationship building and management skills within and across organizations. Able to coach direct reports to improved levels of performance.• Experience in expense management with ability to understand service center-level and customer impacts.Remote/Work-From-Home if the candidate is willing to travel as needed.','Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. Need an accommodation? Email:','United States-Tennessee-Nashville','','','','','','Bus Ops--Operations Mgmt (Bus)','Yes','Yes','Full-time','Day Job','Regular','Standard','Manager of People','Yes, 25 % of the Time','Mar 12, 2018','Operations Manager / Vendor Management (Medicare & Medicaid) - Work at Home

Company Profile
Cigna works with employers and organizations around the world helping employees stay healthy and on the job. We work closely with brokers and consultants to develop innovative programs, help individuals and families improve their health, well-being and sense of security—and lower their medical costs. And, Cigna provides access to a global network of local physicians and hospitals—as well as 24/7/365 live customer service.

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