Senior Manager Clinical Services

Overview

The Senior Manager of Clinical Services will be responsible for driving operational efficiency, product quality, clinical review optimization and alignment to meet client needs for HEDIS, STAR and other health measure chart review and abstraction related services. This role will closely partner with Program and Product Management teams to prioritize innovation and support our market and customer needs.

HEDIS® is a registered trademark of NCQA.

Responsibilities

• Plan, coordinate and manage daily production for HEDIS® abstraction and overreading to ensure meeting SLA’s and timelines. Work with on and offshore contractors/vendors and internal staff to meet staffing and production requirements.
• Develop, implement and monitor department key performance indicators that ensure quality, completeness, and timeliness of core department responsibilities.
• Assist in recruiting and hiring new staff, manage existing staff, and develop and implement training and orientation programs that ensure consistency and accuracy.
• Assist in developing departmental budget, managing expenses, and appropriate resource utilization.
• Deep understanding of business needs of our clients, including challenges they face and other industry trends occurring. Ability to translate these needs into concrete initiatives with strong business cases supporting decisions
• Participate in sales calls/demos to support abstraction offering.
• Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that is able to assist in employing best in class practices to support and drive high levels of internal and external customer satisfaction.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

Qualifications

• Active unrestricted licensure or certification as an RN, LPN, or other related clinical professional in state of residence, BSN/MSN or other advanced healthcare related degree preferred.
• 1-year clinical experience providing direct patient care w/minimum 5 years HEDIS® abstraction experience required.
• 3+ years formal leadership experience.
• 3+ years Project management experience including time-sensitive production-based projects with global distributed teams, contract staff, multiple clients and/or lines of business, preferred.
• Ability to track, trend, and analyze data to identify areas of opportunity for additional action needed at the Abstraction Team Member level.
• Strong proficiency with Microsoft Office
• HEDIS®/abstraction systems experience required, experience with Cotiviti Quality Reporter tool preferred.
• Strong organizational, analytical (business level math/basic statistical analysis), and interpersonal skills.
• Excellent written and verbal communication skills with ability to present data at staff, peer, management and client level.
• Detail and process oriented with focus on efficiency and attention to detail critical to accuracy of work product.

Mental Requirements:

• Multi-tasking and the ability to prioritize and make independent decisions
• Communicating with others to exchange information.
• Problem-solving and thinking critically.
• Completing tasks independently.
• Interpreting data.
• Making timely decisions in the context of a workflow.
• Maintaining focus.
• Assessing the accuracy, neatness and thoroughness of the work assigned.
• Learning new tasks and completing tasks in situations that have a speed or productivity quota.
• Remembering and adhering to processes and protocols.
• Applying established protocols in a timely manner.

Physical Requirements and Working Conditions:

• Must be able to provide high-speed internet access / connectivity and office setup and maintenance.
• Must be able to provide a dedicated, secure work area.
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands and/or fingers.

Base compensation ranges from $120,000 to $145,000. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 12/30/2024

Applications are assessed on a rolling basis. We anticipate that the application window will close on 2/28/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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