Senior Manager, Accreditations and Compliance

Senior Manager, Accreditations and Compliance
Maryland Heights MO – 63043 – St Louis 1 – 14100 Magellan Plaza
Columbia MD – 21046 – 6950 Columbia Gateway Drive
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Job Summary:

Manages accreditation and compliance function for Magellan Network. This includes Network policy development, research of applicable federal, state, accrediting body, and client requirements. Prepares and manages external and internal audits. Monitors and manages the provider sanction and provider appeals functions for Network. Coordinates and provides oversight for credentialing delegation as well as developing and mentoring research and audit staff.

Essential Functions

• Develops implements and provides oversight of the internal QI Plan. Evaluates the performance of the plan and provides technical and/or managerial support as necessary. Implements department goals and objectives, tracking and reporting progress to the department and to Senior Management.

• Manages and provides oversight of the national research program. Evaluates the performance of the program and provides technical and/or managerial support as necessary. Establishes with Project Managers, Implementers, and other Network Managers, as applicable, policy and workflow to meet the needs of standard operations and special projects, including new business RFP research and implementations, system migrations, system maintenance, etc.

• Prepares, manages and leads the national external/internal audit program for Network Operations. Work with CMCs, corporate, and client companies to schedule, prepare for and participate in pre-delegation, delegation, and accrediting body audits ensuring successful outcomes. Coordinates with internal and external leads to facilitate the development and implementation of necessary corrective action plans. Lead for CVO Certification.

• Provides research and support for the national appeal program and related staff. Works with CMCs, corporate, and legal departments ensuring compliance with state and accrediting body standards.

• Manages the national ongoing monitoring and reporting program and related staff. Works with CMCs, corporate, and legal departments ensuring compliance with state and accrediting body standards. Liaison with clinical and legal pertaining to provider sanctions and quality issues. Coordinates reporting of actions to appropriate boards

• Implements and provides oversight of the national credentialing delegation program. Works with SBU, corporate, and vendor companies to schedule, prepare for and participate in pre-delegation and annual delegation audits ensuring successful outcomes. Coordinates with internal and external leads to facilitate the development and implementation of necessary corrective action plans.

• Responsible for interviewing, hiring and managing staff. Defines, with Senior Management, the responsibilities of the department staff and ensures that responsibilities are met in accordance with job definitions. Provides regular feedback to staff regarding individual quality and productivity to established benchmarks. Coaches staff to improve work performance.

Minimum Requirements

Education: BA/BS

Experience: 5-8 years

Job Specific: Three (3) to five (5) years previous supervisory experience or managed care/network management experience; 3-5 years experience with accrediting body compliance, regulatory research, new account/business requirement implementation, or continuous quality improvement protocols

*An equivalent combination of experience and education is acceptable.

Other: Excellent organizational, interpersonal, time management and communication skills; Strong leadership skills; Strong independent decision-making ability; Process and project management ability; Strong influencing, negotiation and analytical skills; detail oriented; Customer/Team Advocate; Flexibility; Positive Attitude; Team Player; Problem Solver; Ability to manage multiple tasks simultaneously; Initiator; Change Agent; Coach; Leader; Risk Taker; Strategic Visionary.

Computer Skills: MS Office

Preferred Qualifications

Education: Bachelors degree in Business, Computers, Management, Health Care or related field and/or related work experience

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