REMOTE Healthcare Process Improvement Manager

A trailblazing fertility and family-building solutions medical benefits organization with over 25 years of success, has proudly supported over 500,000 families on the path to parenthood. To meet the evolving needs of today’s families, our organization is proud of our long-standing legacy in fertility and family well-being services, expanding offerings from pre-conception and fertility to parenting, healthy aging, and beyond. We have dramatically improved patient experience through a new and cutting-edge digital interface, customized to each patient’s journey, and expanded services designed to support the physical, emotional, and social health and happiness

We are the largest, most experienced fertility benefit management company in the country offering inclusive family-building solutions to employers, health plans and individual patients. From integrated fertility management, including medical treatment, pharmacy, and reproductive genetics, to surrogacy and adoption, our mission is to help build families by providing access to the best network of doctors, technology and emotional support at the lowest cost. Our programs include an integrated medical and pharmaceutical model that is unique to the industry. Its dedicated nurse care managers, all with experience in reproductive endocrinology clinics, guide employees through every step of their fertility journey, and are available 24/7.

We are hiring a talented Bachelor’s prepared Process Improvement Manager who comes with strong Performance Management and productivity optimization skills, including reporting, analysis and recommendations. A strong technological background interfacing with IT personnel is required.
MUST have working knowledge of current commercial health insurance product options, including HMO, PPO, EPO, high deductible plans, copay/coinsurance variations, and HRA’s/HSA’s. Additionally, must have knowledge of electronic commerce, including EDI submission and payment of provider claims, EDI submission to payers, EFT, transmission of forms, and web portal interface for providers and members. Knowledge of medical coding, including ICD-10, NDC/GPI, CPT/HCPCS.

MUST live within 3 hours of the NYC metro area to be considered.

Under the direction of the Director of Process Improvement, the PI Manager will be responsible for identifying areas for operational improvement, engage and organize cross-departmental stakeholders, implement changes, ensure testing efforts, and monitor process performance.
Recommends and implements initiatives to improve department efficiency, productivity, workflows, and enhance member and provider experience. Also translates business needs into functional specifications.

• Responsible for program development, implementation, and management of process improvement initiatives.
• Oversee and support the execution of identified process improvement opportunities by working closely with cross-functional teams, including but not limited to IT, Service, Clinical, PMO, Client Success, Finance, Specialty Services, Claims, and Analytics.
• Coordinates, directs, and manages the activities of the department and the process improvement process.
• Assesses business and operational needs for opportunities to improve efficiency, productivity, effectiveness, and accuracy.
• Works with the Director of Healthcare Analysis to develop and deploy an organizational strategy to optimize workflows.
• Uses Lean and Six-Sigma methodology to create and maintain a culture of continuous improvement.
• Responsible for the developing and conducting process improvement training within the organization
• Conduct meetings and disseminates communication related to process improvement activities to senior leadership and staff as needed.

Project Planning and Management:
Develop and oversee detailed project plans, defining project scope, objectives, timelines, budgets, and resource requirements. Utilize project management tools and methodologies to ensure projects are executed effectively and efficiently. Establish milestones and deliverables, ensuring alignment with overall organizational goals and strategic objectives.

Team Leadership and Coordination: Lead cross-functional project teams, fostering a collaborative environment to achieve project goals. Assign tasks, set deadlines, and monitor progress to ensure team members are working cohesively towards common objectives. Facilitate regular team meetings to review progress, address challenges, and keep everyone aligned with project priorities.

Stakeholder Communication: Maintain proactive and transparent communication with all project stakeholders, including senior management, clients, and team members. Provide regular updates on project status, including achievements, potential issues, and changes in scope or timelines. Gather and incorporate stakeholder feedback to refine project plans and ensure stakeholder needs and expectations are met.

Quality and Regulatory Compliance: Ensure all project deliverables adhere to quality standards and comply with relevant regulatory requirements. Implement quality control processes and conduct reviews to verify that project outputs meet the established criteria. Address any non-compliance issues promptly and work with the team to resolve them.

Risk Management: Identify potential project risks and develop comprehensive mitigation strategies to address them. Monitor risk factors throughout the project lifecycle, adjusting plans and resources as necessary to minimize impact. Implement contingency plans to handle unforeseen challenges and maintain project momentum.

Documentation and Reporting: Maintain detailed and accurate project documentation, including project plans, schedules, budgets, and correspondence. Prepare and present progress reports to senior management and other stakeholders, highlighting key achievements, challenges, and areas requiring attention. Ensure documentation is up-to-date and accessible for review and audit purposes.

Process Improvement: Continuously evaluate project management processes and practices, identifying opportunities for improvement. Implement best practices and lessons learned from previous projects to enhance efficiency and effectiveness. Promote a culture of continuous improvement within the project team to drive better outcomes and project success.

Resource Allocation: Manage project resources, including personnel, equipment, and budget. Ensure resources are allocated effectively to meet project demands and constraints. Monitor resource utilization and make adjustments as needed to optimize performance and ensure project goals are achieved within the allocated budget and timeline.

Client and Vendor Coordination: Coordinate with clients and vendors to ensure project requirements are clearly defined and met. Manage vendor relationships and oversee the delivery of services or products to ensure they align with project specifications. Address any issues or discrepancies with vendors to maintain project timelines and quality standards.


KNOWLEDGE, SKILLS AND ABILITIES

Advanced knowledge and experience with Excel, Project and spec software development tools such as JIRA
Knowledge of NCQA Guidelines, URAC Accreditation and Utilization Management desirable.
Experience with pharmacy benefit management, disease management, care management or the pharmaceutical industry desirable.