Manager, Physician Business
Job DescriptionThis position provides physician oversight and management for physicians who perform utilization management services for Magellan's customers with focus on quality, cost effective services provided and compliance with standards, internal and or external/performance guarantees. Continuously evaluates opportunities to enhance PCR (Physician Clinical Review) services ensuring optimal efficiency and effectiveness. Accountable to summarize, produce and communicate operational reports based on defined internal and or external requirements. Responsible for solving issues and/or problems as identified. Responsible for establishing a positive work environment that encourages employee participation in process improvements and commitment to department/company success.
- Directs and monitors all tasks for assigned physicians related to PCR duties and functions for compliance on performance standards (such as TAT, Phone stats, Cases/hr., CMS compliance, etc.) are met with discussion and follow up on identified trends with action plans for correction.
- Coordinates, as needed, invoice preparation for Physician vendor contracts and prepares for payment coordinating with other key departments. Utilizes reports to confirm submissions and corrects identified errors to ensure compliance with turn-around times for contractual payment obligations.
- Reviews and approves timesheets utilizing defined reports to support the time sheet submissions
- Assists with recruitment as requested. Completes Pre Hire calls for new PCRs.
- Supports daily report distribution of call activity, Q volume, Cases worked, Schedule vs actual hours, etc. to identified distribution list and researches variances for suggested resolution.
- Completes reports and/or reviews and approves report summaries for physicians, both internal and external. Completes telephone call recordings and pulls them monthly for compliance and/or productivity reviews.
- Assists with questions and resolution from PCRs and or other staff members.
- Assists with appeal coordination for Fair Hearings.
- Assists with systems (BBI, SABA, access, etc.) questions from physicians.
- Assists with case research on questions from customers.
- Monitors physician staffing hours and makes outreach calls to identified physicians for updates on hours and compliance with schedule.
- Other duties as assigned.
General Job Information
TitleManager, Physician Business
Job FamilyClinical Services Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date6/26/2019
Date Requisition Created6/25/2019
Work ExperienceClinical, Customer Service, Network, Supervisory
EducationBachelors: Business Administration (Required), Bachelors: Health Management (Required), Bachelors: Network Administration
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- Managed care knowledge of provider networks, information systems, and/or clinical services desirable.
- Familiarity with complex operating systems such as IPD, RPD, RADMD, Informa, Onco Auth or EHR's, Cerner, Epic, etc.
- Experience with clinical operations, healthcare reimbursement methodologies, provider data sharing, payment systems and coding.
- Knowledge of healthcare delivery systems.
- Experience working in and/or with Accountable Care Organizations (ACOs).
- 5+ years of call center experience with advancing level of responsibility in areas such as provider services, managed health care, health care, physicians office and/or business experience with at least 3 years at the management level.
- Knowledge of managed healthcare principles.
- Ability to develop, articulate and measure performance of a large, diverse team. Demonstrated ability to collaborate with colleagues within and outside department to achieve mutual performance goals.
- Excellent negotiation, leadership and communication skills.
- Demonstrated proficiency negotiating and consistently meeting or exceeding financial and operational benchmarks for performance.
- Strong working knowledge of MS Office Suite, specifically Excel.
- Strong verbal and written communication skills.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.
“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”