Manager, Pre-Cert Operations

Description

Location : This position based at our Dublin OH campus and is primarily onsite with some hybrid flexibility.

Who we are

Founded in 1999 and headquartered in Central Ohio were a privately-owned independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone and were on a mission to make healthcare simpler and more effective for our millions of members. Our big-hearted tech-savvy team fights to ensure that our members get the care they need when they need it at the most affordable cost thats why we call ourselves Healthcare Warriors.

Were committed to building diverse and inclusive teams more than 2000 of us and counting so if youre excited about this position we encourage you to apply even if your experience doesnt match every requirement.

About the role

The Manager Pre-C ert Operations is responsible for managing the execution of Quantums Pre-Certification delivery. This leader will have primary accountability for performance management escalation triage and audit presentation.

What youll do (Essential Responsibilities)

• Provide direct leadership and subject matter expertise for frontline Pre-Certification nurses
• Ensure a focus on quality consistency and member centricity
• Serves as a clinical subject matter expert for internal and external parties
• Continuously evaluate the staffing distribution and workload to ensure adequate balance. Adjust coverage as needed.
• Own development and performance management of frontline Nurses; maintain focus on key needs / expectations / initiatives
• Ensure onboarding of new staff as needed.
• Conducts routine 1 on 1 development meetings as well as check-in / performance review conversations with direct reports
• Lead the succession planning and IDP process for direct reports to ensure continued professional development.
• Delivers performance feedback. Responsible for performance management and coaching support to develop the team and maximize success of employees
• Assist with day-to-day problem-solving Q&A and protocol guidance for staff
• Facilitate regular team discussions that reinforce key needs / expectations / initiatives promote an awareness of program and staff performance and provide a forum for Q&A.
• Facilitate team huddles to ensure collaboration with workload and case needs
• Operational execution in alignment with strategic programmatic initiatives
• Support development maintenance and execution of processes protocols tools and systems that support program objectives
• Continuously monitor outcomes address gaps and / or identify opportunities for greater programmatic impact as needed
• Ensure compliance with relevant regulatory requirements
• Owner of both consultant and compliance audits through presentation of material answering questions and recapping themes needing addressed. Conducted in collaboration and partnership with Clinical Program Clinical Delivery and Pod leaders
• May support program leadership in development of new product capabilities or solutions
• Collaborate with UM Clinical Operations leadership on the continuous evaluation of processes / protocols and program effectiveness
• Implement process improvements and clinical initiatives to address identified needs as guided by program leadership
• Trend identification root cause analysis and development of corrective / preventative action plans within discipline / frontline delivery
• Available for client implementations as need
• Escalation management and client-facing interaction to triage and address recurring issues
• All other duties as assigned.

What youll bring (Qualifications)

#LI-HW1

#LI-Onsite

Whats in it for you

What you should know

Phone Screen >

Online Assessment(s) >

Interview(s) >

Offer >

Background Check.

Reasonable Accommodation : Should you require reasonable accommodation(s) to participate in the application / interview / selection process or in order to complete the essential duties of the position upon acceptance of a job offer click here to submit a recruitment accommodation request.

Recruiting Scams : Unfortunately scams targeting job seekers are common. To protect our candidates we want to remind you that authorized representatives of Quantum Health will only contact you from an email address ending in @. Quantum Health will never ask for personally identifiable information such as Date of Birth (DOB) Social Security Number (SSN) banking / direct / tax details etc. via email or any other non-secure system nor will we instruct you to make any purchases related to your employment. If you believe youve encountered a recruiting scam report it to the Federal Trade Commission and your states Attorney General.

Required Experience :

Manager

Key Skills

Bidding,Customer Service,Government,IT Strategy,Chemistry,Analytics

Employment Type : Full-Time

Experience : years

Vacancy : 1