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Manager, Provider Data Operations

at CareSource

Posted: 8/24/2019
Job Reference #: *FE4F365D24F0F117
Keywords: operations

Job Description

Requisition Number

Post Date

Manager, Provider Data Operations




Role and Responsibility:

  • Manage day-to-day operations of direct reports to ensure goals and departmental tasks are carried out
  • Continually review data entry processes; implementing process improvements to ensure effectiveness when appropriate
  • Participate in key committees, subcommittees, and/or work groups, as necessary
  • Develop and implement processes to monitor key metrics to ensure accuracy of data, process efficiency & staff performance
  • Develop departmental training and evaluation techniques
  • Responsibility for maintaining all provider networks
  • Provide back-up services to departmental positions, as needed
  • Ensure timely processing of provider networks and maintenance activities
  • Manage network requirements for RFA ‘s / RFP’s
  • Perform basic metrics analysis related to provider networks, claims processing and other related operational performance
  • Provide leadership and direction for the multi-state, multi-product teams across internal and external databases
  • Manage the relationship with IT as required for implementation of initiatives for process improvement through automation within Health Partner Life Cycle (HPLC)
  • Perform cost-benefit and return on investment analyses for proposed initiatives to aid decision-making process as well as collect and analyze data in support of business case creation and realization
  • Perform research into quality, grievance, fraud and abuse or malpractice issues for providers as needed
  • Ensure HPLC activities comply with URAC, NCQA, state and federal regulations
  • Coordinate, produce and analyze management reports and incorporate changes as requested to enhance reporting and/or improve workflow and monitor for trends and patterns
  • Communicate with and provide regular updates to Senior Leadership
  • Demonstrate strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner
  • Perform any other job related instructions, as requested


Education / Experience:

  • Bachelor of Science degree in business related field or equivalent years of relevant work experience is required
  • Minimum of five (5) years of experience in a healthcare environment is required
  • Experience in Provider Services is preferred
  • Minimum of three (3) years leadership experience is preferred

Required Competencies / Knowledge / Skills:

  • Ability to make decisions & problem solve
  • Ability to manage & prioritize multiple tasks
  • Proficient with Microsoft Office to include Word, Excel and PowerPoint
  • Excellent written and verbal communications skills
  • Ability to develop, prioritize and accomplish goals
  • Detail oriented
  • Strong interpersonal skills and high level of professionalism
  • Effective listening and critical thinking skills
  • Effective problem solving skills with attention to detail

Licensure / Certification:

  • None

Working Conditions:

  • General office environment; may be required to sit/stand for long periods of time