Michigan Peer Review Organization
About iMPROve HealthCome join the iMPROve Health team! iMPROve Health is Michigan's Medicare-designated Quality Improvement Organization.
We are both a Cool Place to Work (Crain's Detroit Business) for the last 4 years and one of the Best Places to Work in Healthcare as judged by Modern Healthcare.
As a nonprofit organization, we have more than 35 years' experience improving healthcare across the continuum of care using evidence-based and data-driven logic.
iMPROve Health provides medical consulting and review, as well as data analysis to federal agencies, state Medicaid and public health organizations, healthcare facilities, private health plans and other third-party payers.
We also have extensive experience completing thoughtful and impartial utilization review, dispute resolution and peer reviews.
Our goal is simple - to help healthcare get better!This position is 100% remote and provides the opportunity to work virtually with team members from anywhere within the United States.
We pride ourselves on providing a great work/life balance for employees, while also providing the ability to promote their career development and gain new skills through employee education opportunities.
iMPROve Health offers a wonderful benefit package that includes medical, dental, vision, life insurance, short term and long-term disability, and a generous 401k match.
iMPROve Health is committed to improving the quality, safety, and efficiency of healthcare.
Although we do not see patients, we are healthcare professionals (including physicians and nurses) and consultants who work with healthcare providers to promote the adoption and use of evidence-based best practices and processes to achieve our healthcare quality goals.
Our services offer our clients and partners access to a proven, impartial, connected resource that understands the intricacies of healthcare.
It is our #1 priority to provide thoughtful evidence-based strategies and solutions that help them achieve their healthcare quality improvement goals and outcomes.
iMPROve Health is an equal employment opportunity employer.
Must be able to work M-F normal business hours in EST.
Summary:
The Program Manager works closely with the managing director of IDR Services and is responsible for overseeing the day-to-day operations of the Federal IDRE program, including ensuring the quality and timeliness of all deliverables.
They work with the managing director and other team members to determine tactics for increasing review service business lines, along with actively responding to new opportunities.
The program manager provides guidance to direct reports, mentors and guides team members and works to identify efficiencies.
DUTIES AND
Responsibilities:
Provide oversight and direction of the Federal contract deliverables and IDRE team to facilitate alignment with the No Surprises Act.
Manage daily operations of assigned project/contract area, including working with the director to establish and monitor budgets.
Other operations activities include initiating and updating job aids, standard operating procedures, roles and responsibilities and monitoring workflow for efficiencies.
Mentor, guide and provide day-to-day supervision of direct reports, project specialists and administrative assistants, including coaching, facilitating, and implementing methods aimed at creating a high-functioning integrative team.
Responsibilities include delegating activities according to job and skill levels.
Manage daily operations of the assigned project/contract area working closely with the team members and use project management concepts to ensure dispute timeliness.
Work with arbitration coordinator, contracted arbitrators, and other subject matter experts (SMEs) to ensure case review completeness and case meets the standards outlined in the Federal IDR process.
Research and guide the team in developing processes and procedures that meet the rules (Requirements Related to Surprise Billing) and guidance set forth by the U.
S.
Departments of Health and Human Services, Labor, and the Treasury (the Departments) related to the applicability of the Federal IDRE process, review of disputes and payment determinations.
Apply medical review background and/or claims administration knowledge to develop review pathways and other resource tools fostering process and workflow efficiency.
Comprehend and monitor all contract aspects related to assigned task(s), including deliverable schedule and metrics, keeping the director informed of potential risks.
Ensure all program activities are delivered in accordance with quality, performance, timeliness, and financial metrics working with team members to mitigate barriers.
Proactively identify challenges and deploy risk mitigation strategies.
Complete tasks as designated by the director.
Actively partake in identifying and securing new business opportunities.
Apply quality improvement principles and acquired technical expertise to implement strategies that support attainment of program goals.
Model accountability for self-learning activities as well as the sharing and transfer of knowledge.
Attend and/or presents at local, state or national conferences/meetings, as appropriate.
Develop external relationships and maintain customer satisfaction.
Adhere to all relevant compliance regulations (HIPAA, FISMA, URAC, CMS).
Other duties as assignedEDUCATION AND/OR
Experience:
Bachelor's degree in nursing or Bachelors degree in other related healthcare fields required.
Master's degree preferred.
RN Preferred Project Management and Quality Improvement certifications preferred but not required.
Minimum of 5 years of clinical or related healthcare experience required.
Minimum 3-year management experience required.
Healthcare claims review experience required.
Knowledge of the Federal No Surprises Act and Utilization Management/Utilization Review preferred.
Experience implementing quality improvement methodology and tools required.
Quality Improvement certification a plus.
Project management and staff supervisory experience required.
Project Management certification a plus.
Ability to read and interpret federal/state programs and regulations requiredExcellent written and verbal communication skills requiredExceptional organizational, project management and customer service skills requiredExperience with written and electronic documentation review requiredAbility to multi-task working on more than one contract/project simultaneously requiredAbility and willingness to work outside of normal business hours as needed.
About the Company:
Michigan Peer Review Organization.
Estimated Salary: $20 to $28 per hour based on qualifications.
We are both a Cool Place to Work (Crain's Detroit Business) for the last 4 years and one of the Best Places to Work in Healthcare as judged by Modern Healthcare.
As a nonprofit organization, we have more than 35 years' experience improving healthcare across the continuum of care using evidence-based and data-driven logic.
iMPROve Health provides medical consulting and review, as well as data analysis to federal agencies, state Medicaid and public health organizations, healthcare facilities, private health plans and other third-party payers.
We also have extensive experience completing thoughtful and impartial utilization review, dispute resolution and peer reviews.
Our goal is simple - to help healthcare get better!This position is 100% remote and provides the opportunity to work virtually with team members from anywhere within the United States.
We pride ourselves on providing a great work/life balance for employees, while also providing the ability to promote their career development and gain new skills through employee education opportunities.
iMPROve Health offers a wonderful benefit package that includes medical, dental, vision, life insurance, short term and long-term disability, and a generous 401k match.
iMPROve Health is committed to improving the quality, safety, and efficiency of healthcare.
Although we do not see patients, we are healthcare professionals (including physicians and nurses) and consultants who work with healthcare providers to promote the adoption and use of evidence-based best practices and processes to achieve our healthcare quality goals.
Our services offer our clients and partners access to a proven, impartial, connected resource that understands the intricacies of healthcare.
It is our #1 priority to provide thoughtful evidence-based strategies and solutions that help them achieve their healthcare quality improvement goals and outcomes.
iMPROve Health is an equal employment opportunity employer.
Must be able to work M-F normal business hours in EST.
Summary:
The Program Manager works closely with the managing director of IDR Services and is responsible for overseeing the day-to-day operations of the Federal IDRE program, including ensuring the quality and timeliness of all deliverables.
They work with the managing director and other team members to determine tactics for increasing review service business lines, along with actively responding to new opportunities.
The program manager provides guidance to direct reports, mentors and guides team members and works to identify efficiencies.
DUTIES AND
Responsibilities:
Provide oversight and direction of the Federal contract deliverables and IDRE team to facilitate alignment with the No Surprises Act.
Manage daily operations of assigned project/contract area, including working with the director to establish and monitor budgets.
Other operations activities include initiating and updating job aids, standard operating procedures, roles and responsibilities and monitoring workflow for efficiencies.
Mentor, guide and provide day-to-day supervision of direct reports, project specialists and administrative assistants, including coaching, facilitating, and implementing methods aimed at creating a high-functioning integrative team.
Responsibilities include delegating activities according to job and skill levels.
Manage daily operations of the assigned project/contract area working closely with the team members and use project management concepts to ensure dispute timeliness.
Work with arbitration coordinator, contracted arbitrators, and other subject matter experts (SMEs) to ensure case review completeness and case meets the standards outlined in the Federal IDR process.
Research and guide the team in developing processes and procedures that meet the rules (Requirements Related to Surprise Billing) and guidance set forth by the U.
S.
Departments of Health and Human Services, Labor, and the Treasury (the Departments) related to the applicability of the Federal IDRE process, review of disputes and payment determinations.
Apply medical review background and/or claims administration knowledge to develop review pathways and other resource tools fostering process and workflow efficiency.
Comprehend and monitor all contract aspects related to assigned task(s), including deliverable schedule and metrics, keeping the director informed of potential risks.
Ensure all program activities are delivered in accordance with quality, performance, timeliness, and financial metrics working with team members to mitigate barriers.
Proactively identify challenges and deploy risk mitigation strategies.
Complete tasks as designated by the director.
Actively partake in identifying and securing new business opportunities.
Apply quality improvement principles and acquired technical expertise to implement strategies that support attainment of program goals.
Model accountability for self-learning activities as well as the sharing and transfer of knowledge.
Attend and/or presents at local, state or national conferences/meetings, as appropriate.
Develop external relationships and maintain customer satisfaction.
Adhere to all relevant compliance regulations (HIPAA, FISMA, URAC, CMS).
Other duties as assignedEDUCATION AND/OR
Experience:
Bachelor's degree in nursing or Bachelors degree in other related healthcare fields required.
Master's degree preferred.
RN Preferred Project Management and Quality Improvement certifications preferred but not required.
Minimum of 5 years of clinical or related healthcare experience required.
Minimum 3-year management experience required.
Healthcare claims review experience required.
Knowledge of the Federal No Surprises Act and Utilization Management/Utilization Review preferred.
Experience implementing quality improvement methodology and tools required.
Quality Improvement certification a plus.
Project management and staff supervisory experience required.
Project Management certification a plus.
Ability to read and interpret federal/state programs and regulations requiredExcellent written and verbal communication skills requiredExceptional organizational, project management and customer service skills requiredExperience with written and electronic documentation review requiredAbility to multi-task working on more than one contract/project simultaneously requiredAbility and willingness to work outside of normal business hours as needed.
About the Company:
Michigan Peer Review Organization.
Estimated Salary: $20 to $28 per hour based on qualifications.
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