- Develops the departmental budget and is responsible for adherence to budget, including maintaining records and systems to track performance.
- Acts as the principle contact for security issues with the federal government.
- Manages the integrity program and appeals process, including ongoing evaluation of the staff who research and prepare appeals for presentation. Decision maker for all post service, network and benefit appeals. Acts as second level manager for grievances. Works with patients and or vendor to reach resolution. Refers those cases that require additional attention to the Executive Director.
- Maintains monthly reports that give clear, measurable information to the executive team and Quality Committee.
- Manages the orientation and training and ongoing performance feedback of staff; complete yearly performance appraisals on each employee and interim updates as needed/required.
- Participates in the planning of ongoing staff development programs focused on improving the quality of the services delivered in the department.
- Manages the appeals process, including ongoing evaluation of staff who research and prepare appeals for presentation. Decision maker for all post-services, network and benefit appeals. Acts as second-level manager for grievances. Works with patients or vendors to reach resolution. Refers those cases that require additional attention to the Executive Director.
- Registered Nurse and experience as RN - Preferred
- Bachelor's degree in Healthcare Administration or Business Administration - Preferred
- Four years of experience in a healthcare business office or member services experience with progressive responsibilities - Required
- Three years of experience in a managerial role within Pacific Medical Centers or a commercial managed care plan - Required
-
Gilead Sciences, Inc. Seattle, United StatesFor Current Gilead Employees and Contractors: · Please log onto your Internal Career Site to apply for this job. · At Gilead, we're creating a healthier world for all people. For more than 35 years, we've tackled diseases such as HIV, viral hepatitis, COVID-19 and cancer - workin ...
-
Gilead Sciences, Inc. Seattle, United StatesFor Current Gilead Employees and Contractors: · Please log onto your Internal Career Site to apply for this job. · At Gilead, we're creating a healthier world for all people. For more than 35 years, we've tackled diseases such as HIV, viral hepatitis, COVID-19 and cancer - workin ...
-
Director, Clinical Operations- Oncology
1 week ago
Gilead Sciences, Inc. Seattle, United StatesFor Current Gilead Employees and Contractors: · Please log onto your Internal Career Site to apply for this job. · At Gilead, we're creating a healthier world for all people. For more than 35 years, we've tackled diseases such as HIV, viral hepatitis, COVID-19 and cancer - workin ...
-
Director Medical Surgical
2 days ago
CommonSpirit Health Seattle, Washington, United States PermanentOverview: · Virginia Mason Franciscan Health brings together two award-winning health systems in Washington state CHI Franciscan and Virginia Mason. As one integrated health system with the most patient access points in western Washington, our team includes 18,000 staff and nearl ...
-
Program Operations Specialist
1 week ago
University of Washington Seattle, United States Full timeUW Medical Center-Montlake - OTO HEAD AND NECK SURG has an outstanding opportunity for a PROGRAM OPERATIONS SPECIALIST. · WORK SCHEDULE · * Full-Time · * Day Shift · POSITION HIGHLIGHTS · As a member of the health care team, the Program Operations Specialist performs program deve ...
-
Startup Operations and Budget Specialist
1 week ago
Fred Hutchinson Cancer Research Center Seattle, United StatesOverview · Fred Hutchinson Cancer Center is an independent, nonprofit organization providing adult cancer treatment and groundbreaking research focused on cancer and infectious diseases. Based in Seattle, Fred Hutch is the only National Cancer Institute-designated cancer center i ...
-
Supervisor Nursing
2 weeks ago
Providence Health & Services Seattle, WA, United StatesSupervisor Nursing - Labor and Delivery @ Swedish First Hill · Full Time (40 Hour Week) · Variable Shifts · 8 Hour Shifts · Fantastic benefits and relocation package offered by Providence that begin on your first day of employment. Join us, and find out how many ways we offer you ...
-
Clinical Research Coordinator II
1 week ago
Fred Hutchinson Cancer Research Center Seattle, United StatesOverview · Fred Hutchinson Cancer Center is an independent, nonprofit organization providing adult cancer treatment and groundbreaking research focused on cancer and infectious diseases. Based in Seattle, Fred Hutch is the only National Cancer Institute-designated cancer center i ...
-
Startup Operations and Budget Specialist
1 week ago
Fred Hutchinson Cancer Research Center Seattle, United StatesOverview · Fred Hutchinson Cancer Center is an independent, nonprofit organization providing adult cancer treatment and groundbreaking research focused on cancer and infectious diseases. Based in Seattle, Fred Hutch is the only National Cancer Institute-designated cancer center i ...
-
Clinical Director of Mobile Response
3 weeks ago
DESC Seattle, United StatesApply · Job Type · Full-time · Description · Days Off: Saturday, Sunday · Shift: Office Day · Insurance Benefits: Dental, Life, Long-term Disability, Medical (no premiums/payroll deductions for employee coverage) · Other Benefits: Employee Assistance Program (EAP), Flexible Spend ...
-
HLA Lab Manager
1 week ago
Fred Hutchinson Cancer Research Center Seattle, United StatesOverview · Fred Hutchinson Cancer Center is an independent, nonprofit organization providing adult cancer treatment and groundbreaking research focused on cancer and infectious diseases. Based in Seattle, Fred Hutch is the only National Cancer Institute-designated cancer center i ...
-
Research Study Coordinator 1
3 weeks ago
University of Washington Seattle, United StatesAs a UW employee, you have a unique opportunity to change lives on our campuses, in our state and around the world. UW employees offer their boundless energy, creative problem-solving skills and dedication to build stronger minds and a healthier world. · UW faculty and staff also ...
-
Ophthalmic Technician Supervisor
3 weeks ago
University of Washington Seattle, United StatesThe Eye Institute at Harborview has an newly created position that is an outstanding opportunity for a full-time, day shift, OPHTHALMIC TECHNICIAN SUPERVISOR to join our team · WORK SCHEDULE · 40 hours per week · Monday - Friday · Day Shift · POSITION HIGHLIGHTS · Provide oversig ...
-
Startup Operations and Budget Specialist
1 week ago
Fred Hutchinson Cancer Research Center Seattle, United StatesOverview · Fred Hutchinson Cancer Center is an independent, nonprofit organization providing adult cancer treatment and groundbreaking research focused on cancer and infectious diseases. Based in Seattle, Fred Hutch is the only National Cancer Institute-designated cancer center i ...
-
Clinical Research Coordinator II
2 weeks ago
Fred Hutchinson Cancer Research Center Seattle, United StatesOverview · Fred Hutchinson Cancer Center is an independent, nonprofit organization providing adult cancer treatment and groundbreaking research focused on cancer and infectious diseases. Based in Seattle, Fred Hutch is the only National Cancer Institute-designated cancer center i ...
-
Clinical Technologist I
3 weeks ago
Fred Hutchinson Cancer Research Center Seattle, United StatesOverview · Fred Hutchinson Cancer Center is an independent, nonprofit organization providing adult cancer treatment and groundbreaking research focused on cancer and infectious diseases. Based in Seattle, Fred Hutch is the only National Cancer Institute-designated cancer center i ...
-
University of Washington Seattle, United StatesAs a UW employee, you have a unique opportunity to change lives on our campuses, in our state and around the world. UW employees offer their boundless energy, creative problem-solving skills and dedication to build stronger minds and a healthier world. · UW faculty and staff also ...
-
University of Washington Seattle, United StatesThe University of Washington Tacoma is an anchor institution that is deeply invested in its local communities and in student success. As one of three campuses of a world-class university, UW Tacoma is dedicated to interdisciplinary and innovative teaching and scholarship and to e ...
-
Manager Rehabilitation Services
1 week ago
Providence Health & Services Seattle, United StatesUnder the direction of the Director of Ancillary Services, provides daily supervision and leadership for therapy operations at all locations. Oversees daily therapy operations including patient education, clinical regulatory compliance, scheduling of staff, performance management ...
-
Residential Counselor
3 weeks ago
DESC Seattle, United StatesApply · Job Type · Full-time · Description · Days Off: Tuesday, Wednesday · Shift: Day · Insurance Benefits: Medical (no premiums/payroll deductions for employee coverage), Dental, Life, Long-term Disability · Other Benefits: Employee Assistance Program (EAP), Flexible Spending A ...
Director - USFHP Clinical Operations - Seattle, United States - Pacific Medical Centers
Description
Overview:
The director provides leadership for USFHP clinical operations: including care management and the clinical quality management program. In collaboration with the Executive Director, develops and implements policies and procedures, staff training materials, and process protocols. Oversight for ensuring compliance with all Department of Defense contract and policy requirements. Responsible for operational budget monitoring. Directly responsible for member satisfaction and develops and implements programs to improve results. Serves on the national USFHP Alliance Operations Committee as the principal PMC representative. Responsible for developing and ensuring regular reporting and analysis of data to support the functions of the entire division.
Provides reports and analysis to the USFHP Quality and Patient Safety Committee and the Quality and Patient Experience Committee of the Community Board of Directors.
Serves as the principal internal manager for the MCA module of Athena GE-Centricity.Promotes service excellence and fosters teamwork, manages the leads of the departments to ensure adequate resources in each, including setting expectations for cross training.
Essential Functions:
Responsible for managing the departments outlined in the job summary that is responsible for the provision of services under the USFHP contract with the Department of Defense.
Actively solicits customer feedback on performance of assigned departments; resolves customer complaints, refers unresolved complaints onto the Executive Director as needed.
Qualification & Experience:
At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others.
We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected.
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Requsition ID: 257141
Company:
Pacific Medical Jobs
Job Category:
General Operations
Job Function:
Operations
Job Schedule:
Full time
Job Shift:
Day
Career Track:
Leadership
Department: 3060 WA USFHP
Address:
WA Seattle 1226 S Judkins St
Work Location:
PACMED Q5-Seattle
Pay Range:
$ $100.22
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
