Career Center

Department Overview

This position is directly responsible for the operational management of the ambulatory centralized managed care activities within OHSU and OHSU's partners and affiliates. Managed care activities include insurance benefit verification, prior authorization, and patient estimates. Ambulatory departments that currently receive services through the centralized team include the Bone Marrow Transplant, Cardiology, Center for Women's Health, Craniofacial Disorders, Diagnostic Imaging, Endocrinology & Diabetes, Food & Nutrition, Genetic Counseling, Hematology/Oncology, Hospital Dental Services, Infusion, Neurology, Oral Maxillofacial Surgery, Pediatric Specialties, Perinatology, Pulmonology, Rheumatology, Sleep Medicine, and Student Health and Wellness. This position also works closely with the Referrals system's team who manages the referral application workflows within Epic and all associated projects.

This position is responsible to assist with maintaining and developing key performance indicators and reporting, to ensure transparency at the organizational and departmental level. This role will work to ensure that the Centralized Managed Care department is consistently meeting service level agreements. If gaps in performance exist, this position will be expected to engage in process improvement initiatives with key stakeholders across the OHSU system to correct and improve. This includes ongoing monthly investigation of front end no auth denials to identify trends and improve workflows.

The Centralized Managed Care Manager helps to align and standardize Managed Care and Price Estimate workflows, operational workflows, training, and metrics across OHSU (for both centralized and non-centralized teams) and OHSU Health partner organizations, both current and future. This position will keep apprised of and recommend best practices and emerging technologies that will help to automate and improve processes. In addition, this position helps to lead projects across the OHSU system that work to achieve greater price transparency for our patients.

The Centralized Managed Care Manager supports the OHSU mission of providing high quality, compassionate, and respectful health care to our patients. This position assures compliance with departmental and OHSU quality and compliance standards, patient confidentiality, privacy and security, and performance expectations. This position is responsible for managing operations to ensure that internal and external customer service, revenue cycle, and financial goals are met. The incumbant works with leadership in each practice/department to ensure workflows best support the patient and department needs. This role focuses on the performance of their staff and ensures that the team is a leader in the healthcare industry for efficient patient-centered referral processing.

Function/Duties of Position

• Personnel Management: Complete supervision of Ambulatory Centralized Managed Care team including interviewing, hiring, training and orientation, work assignment, staffing, performance monitoring, ongoing feedback, counseling, disciplinary procedures up to and including dismissal and response to grievances. Specific tasks include:
  • Direct supervision of the Ambulatory Centralized Managed Care, Assigns and prioritizes department work expectations. Monitors daily workload to adjust work assignments as needed to ensure accurate and timely completion. Develops corrective action plans as needed. Adjusts staffing and resources in order to meet department objectives and exceed customer service performance standards.
  • Monitors staff activity for accuracy, competency, customer service skills, effectiveness, performance standards, OHSU core competencies, and compliance with Centralized Managed Care and Price Estimates Department and OHSU policies.
  • Ensures all initial and ongoing training, orientation, staff meeting attendance, and in-service requirements are met.
  • Conducts GROW conversations and develops coaching and corrective action plans as needed to build and maintain a work environment that reflects a positive atmosphere, high employee satisfaction and competence, and a strong evidence of teamwork in which diversity is encouraged and honored. Encourages staff participation in planning, decision-making, and problem solving.
  • Recommends change/initiates performance standards for staff and department to be in alignment with changes to internal and external demands.
  • Monitors staff attendance and timekeeping practices.
  • Identifies developmental needs of staff, individually and department wide, coordinates training and develops in-services to meet these needs.

• Operations Management: Helps to standardize managed care, and price estimate workflows across OHSU Health. Measures quality indicators to ensure that staff provide high quality customer service to both external and internal customers. Measures for staff include accuracy and volume of work performed, prompt and professional communication efforts, customer contact skills, appropriate problem-solving skills, ability to learn and use available information technology, standard complaint processing, positive and respectful peer communications and relationship skills in providing coverage for the department's internal service needs.
• • Maintains skills in managed care, insurance verification and requirements, Referrals Application within Epic, Price Estimates and cash collection. Serves as a subject matter expert in developing and enhancing training for all staff who perform these tasks.
  • Monitors department performance in meeting identified goals and standards. Initiates performance improvement projects if team is not meeting goals, in order to improve performance and foster an environment of continuous improvement.
  • Communicates directly with patients, OHSU management staff, internal physicians, community physicians, agency staff, insurance representatives and others as necessary to ensure financial coverage at OHSU. Triages and resolves or forwards patient complaints.
  • Works collaboratively with the Centralized Managed Care Assistant Director and Patient Access Services Director to develop operational tactics to meet defined strategic goals. Identifies and develops opportunities to enhance patient satisfaction, price transparency, and employee satisfaction, interdepartmental dependencies, improve revenue, reduce cost of operations, and effectively utilize resources.
  • Works collaboratively with Department Managers, Patient Care Services, Ambulatory Services, Care Management, Health Information Management, ITG, Human Resources, and Patient Business Services to review, develop, and refine shared processes, to evaluate the efficacy of Referrals processes and enhancements, and to seek solutions for ongoing system and process

• Administrative Operations:
• • Helps to Identify cost saving measures.
  • Participates in strategic planning, developing short and long-term goals, and reviews ongoing system-wide projects involving Referrals, Ambulatory Managed Care, and Price Estimates processes, and other managerial tasks.
  • Monitors departmental compliance with government, professional, and internal regulations including DNV, CMS, OHSU Corporate Compliance, and OHSU labor unions. Develops and/or helps to update policies and procedures to meet objectives as needed.
  • Attends monthly hospital management meetings.
  • Participates in and/or coordinates committees and quality improvement projects as requested.
  • Receive reports of denials due to lack of prior authorization from the Denial Coordinator. Assists in implementing efforts to reduce the occurrence of denials and write-offs.
  • Provide reports to Revenue Cycle Leadership, Practice Managers, and Department Administrators across the OHSU system on denials and write-offs issues or complaints. Makes recommendations to resolve ongoing system, operations, or process issues. Seeks feedback on quality of service metrics to improve financial and customer service operations.

• Performance and Quality:
  • Assures key performance indicators and quality and accountability measures are in place to ensure team success. Maintains a strong leadership team for Patient Access Services including managers and supervisors. Develops appropriate staffing plans to ensure team performance is achieved. Provides regular updates to leadership on progress related to department performance, progress toward goals, strategic initiatives, and major projects, specifying opportunities and risks.

• Variance Analysis.
• • Perform monthly analysis of actual expenses as compared to budget.
  • Ensures system is in place to validate expenditures.
  • Reviews Fund Summary and Productivity reports; Review General Ledger as necessary to explain variance to budget and identify errors.
  • Reviews monthly departmental payroll reports to ensure accuracy in oracle records driving payroll expenditures.
  • Communicates explanation of variances to Director each month.
  • Regularly provides productivity updates and reallocate resources as necessary to reduce financial risk and enhance patient experience.

Required Qualifications

Education:

• Bachelor's Degree in healthcare administration, healthcare management, business administration or related field OR
• Equivalent combination of education and experience 4 years' experience in hospital/clinic admissions and registration with progressively responsible experience.
• 2 years leadership experience.

Experience:

• At least three years' experience in a complex, multifaceted healthcare setting; Experience should include exposure to ambulatory and ancillary workflows, as well as hospital and professional billing.
• At least one year of Management experience in Healthcare.

Job Related Knowledge, Skills and Abilities (Competencies):

• Healthcare revenue cycle experience.
• Excellent oral and written communication skills, complex decision making analysis and an ability to develop concise communications.
• Must be familiar with Microsoft Excel and Visio.
• Must have superb organizational skills and strong customer service orientation and experience.
• Must have ability to work autonomously, be flexible and able to shift priorities on short notice.
• The ideal candidate is driven by achieving outcomes in a timely manner.

Preferred Qualifications

Education:

• Coursework in Healthcare and/or Education. Master's Degree

Experience:

• Specific experience with and integrated health record, Epic preferred.

Additional Details

8 hour shift during operating hours 7am-5:30pm, although the position is expected to work standard Monday - Friday business hours, there will be times when availability is necessary on weekends and during the evening.

All are welcome