As a mission-driven health plan serving all 62 counties of New York State, Fidelis Care provides quality, affordable health insurance coverage for children and adults of all ages and at all stages of life. Central to our mission is our commitment to be a health care partner, working closely with our members and providers to ensure that everyone receives the care they need, when they need it. From the beginning, Fidelis Care has worked to be part of the social fabric of local communities, impacting people’s lives with one of the most basic human rights – access to quality health care and services, close to home.
Provides daily operational support to the Managed Long Term Care (MLTC) Associate Director; responsible to develop, implement, and monitor the essential operational processes, member assessments, and service authorizations that will enable the department to meet and exceed goals, maintain regulatory compliance, improve quality, and promote overall efficiency and effectiveness.
Essential Functions and Responsibilities
- Support the analysis and redesign of operational processes to improve efficiency and effectiveness.
- Research and identify industry best practices to achieve optimal operational outcomes; develop mechanisms to proactively identify and remediate issues.
- Use objective tools, information, and feedback to set operational performance goals for individual, team, and unit; measure and evaluate operational effectiveness; compare measurement results to standards and lead performance improvement to close identified gaps.
- Manage business processes to ensure consistency and adherence to policies and procedures; provide project management leadership to projects as assigned by the Clinical Director, MLTC.
- Develop and maintain documentation necessary to support consistent, operationally sound processes, tip sheets, standard operating procedures, and audit tools.
- Identify trends pertaining to customer complaints; determine root cause; recommend and implement systemic solutions to improve the customer experience.
- Manage and optimize the use of technology, staff and resources; assign staff for specific responsibilities, deploy technology for patient assessments and care management; reassign resources when needed and restructure work processes for improved efficiency and effectiveness.
- Communicate operational priorities throughout the department; answer questions, explain policies and procedures, share information, and maintain open communication channels between management and day to day operations.
Work Related Experience:
- One to three years Supervisory experience: MLTC, Home Care, or Insurance Industry experience preferred.
- One to three years Supervisory experience in managing individuals who provide quality Case and Disease management services and apply clinical judgment to members to identify the most appropriate plan of care for each member from initial evaluation through treatment and discharge procedures.
- Experience Working in Heavily Regulated Environment: Monitor compliance of departmental policies and procedures to meet organizational initiatives and regulatory requirements.
- Proficiency in Microsoft Office: Excel, Word, Access; Outlook.
- Business Analysis Knowledge: Skilled to work in a fast paced environment. Must have strong analytical and problem solving skills.
- Managing diverse staff; execute corporate function effectively; ability to communicate professionally and with cultural sensitivity.
- Customer Service: Skilled to communicate with all levels of management, internal and external customers.
- Ability to work well as a member of a team or independently.
- Effective Business Communication: Skilled in communicating with technical and business constituencies in writing effective business specifications and requirements.
Education, License, and Certification Requirements
- Bachelors Degree preferred.
Job Type: Full-time
- Supervisory: 3 years (Required)