Clinical Audit and Outlier Program Manager Job in Newark, New Jersey US
Job Summary
This role has responsibility for the Clinical Auditing and Monitoring team and also has oversight of the Physician Outlier Program including oversight of two vendors who support the pre and post payment audits of providers identified for either component of the overall Horizon Outlier Program. Position requires the ability to work with Cross Divisional work group to facilitate the Physician Outlier Program including but not limited to: Special Investigations, Service, Network Operations and Finance
Job Qualifications
Education/Experience:
- 4 Year College degree required
- 4+ years of Project management experience required
- 2+ years of supervisory experience preferred
Additional licensing, certifications, registrations:
- Project management Certification preferred
Knowledge:
- Working knowledge of Horizon’s Network Operations ;
- Working knowledge of Horizon Claims Systems and billing practices
- Proficient in MS Word; Power Point and Excel
Skills and Abilities:
- Excellent Communication and presentation skills (Verbal and written) since this is a direct business facing role.
- Must be client service focused with effective ability to empathize.
- Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties.
- Must be detail oriented with strong organizational and data processing skills. Proven ability to follow detailed instructions is essential, along with proven problem solving skills.
- Proven analytical, research and problem solving skills a must.
- Must demonstrate the ability to learn quickly and apply learning to new situations. Must exhibit flexibility to change as appropriate.
- Must demonstrate the ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
- Exhibits an energetic, inquisitive, positive approach to problem solving.
- Demonstrated ability to make decisions with little need for direction and to function effectively as a team-oriented, self-starter working across cross-functional lines.
- Experience in successfully leading cross-functional teams to achieve improvements.
- Must have a demonstrated ability to expand new business, grow client relationships and obtain client referrals.
- Must have strong entrepreneurial business development, negotiation, relationship building, and networking skills.
- Demonstrated management experience with a focus on customer service, goal setting, and coaching. Exhibits proven leadership, delegation and project management skills.
- Proven ability to influence without authority.
- Must be able to share own professional insights, expertise, and knowledge to develop critical thinking across the business.
Travel (If Applicable):
Minimal as required
Scope of Accountabilities:
- Supervise staff of 5 direct reports and cross functional team of SMEs
- Oversight of two vendors
- Annual Medical Cost Savings Goals in excess of $5M
- Operating budget in excess of $2M