Program Manager - Mississippi
As the Program Manager, you will be responsible for prior authorization and utilization management operational activities, account management, and business development for UM/QIO MSDOM program as well as implementation of contract requirements and operational management. This includes being the primary contact for MSDOM, team accountability for evaluation measures, deliverables, or project requirements. You will be responsible for monitoring and overseeing compliance in accordance with client and contract deliverables as well as service/accreditation requirements as applicable.Essential Functions Acts as primary contact for client (MSDOM) and manages the day-to-day operations of multiple and diverse lines of services and/or contracts/programs, including Prior Authorization (PA), Utilization Management (UM), and Care Management activities. Exercise independent judgment and discretion while overseeing and leading the team in the creation, implementation, evaluation, and ongoing management of a strategic plan to ensure contract deliverables/program requirements and evaluation measures/metrics are met and/or exceeded within assigned funding/budget. Facilitate analyses and initiatives for action plans as needed. Develop and maintain relationships with stakeholders as well as lead discussions and work with providers to refine procedures for submissions. Provide technical assistance, including issue research and resolution. Develop and implement process improvement methods for an organization whose philosophy is continual improvement. Depending on the scope of the assigned area, you may facilitate national programs/projects. Ensure the operations are completed in a timely, satisfactory, and compliant manner within the assigned funding/budget. Participate in sales, business development, and proposal work activities including the development of concept papers, contributing content, or review of proposals as a subject matter expert. You will also have financial accountability for monitoring budgets and financials for assigned contracts. Coach, guide, and direct team members to achieve individual, team, and organizational objectives. You will fulfill the Telligen Management Philosophy that Managers coach, engage, and support our people to achieve results. Provide resources and support as needed, including completing the project and contract reviews, to meet the departmental and Company goals and specific contract/program requirements. Represent the Company and present at meetings and/or conferences. Work externally with providers or clients as assigned. Make recommendations for improvements and/or efficiencies to management. Initiate opportunities to expand knowledge, skill development, and certifications that enhance quality improvement activities and the achievement of contract deliverables. Stay abreast of industry trends and changes. Ensure data is maintained accurately and in a confidential environment. Requirements Two or Four-year degree in nursing required, with health care, business, public health, or a related field and/or equivalent training and/or experience 7
years experience working with Medicaid, government health plans, or authorization programs in the healthcare environment; including some prior authorization, utilization management (UM), care management, and/or healthcare quality improvement 3
years managing projects and/or professional clinical and non-clinical staff Background in operations, operational efficiency, and KPI's Demonstrated experience working in a fast-paced and deadline-driven environment Knowledge of State and Federal rules and regulations that drive UM process and scope of work. Must be located in the State of Mississippi Must be able to report to the local office daily. This is not a remote position. We are unable to consider candidates outside of the United States, candidates in the state of California, or those in US Minor outlying islands and territories. COMMITMENT TO SAFETYAs part of our commitment to health and safety,some roles may require additional health protocols (i.e. personal protective equipment or vaccination)Who We Are:
Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise.Health has changed a lot through our 50-year history, but what has remained constant is that we care deeply about who we serve and what we do. Our success is built on our ability to adapt, respond to client needs, and offer innovative solutions.Our business is our people and we're looking for talented individuals who not only believe in our mission but who are ready to take ownership and make a difference in the lives of people, in the world of health. Learn more about who we are and what we do atwww.telligen.com/about-usAre you Ready?We're on a mission to transform lives and economies by improving health and getting there means following through on our values of Ownership, Community, Ingenuity & Integrity.Ownership:
As a 100% employee-owned company, our employee-owners drive our business, our solutions, and share in our success. When employee-owners grow and thrive, we all win.Community:
Putting others first and being a good corporate partner wherever we work, and play makes us who we are. We Show Up. For our clients, for our communities, and for each other.Ingenuity:
We're a team of passionate professionals driven by hard work and big ideas. We understand that high-value breakthroughs come from taking calculated risks. If it will benefit our clients and advance our mission, we're all ears. We celebrate free-thinking and challenge the status quo, so brainstorm away!Integrity:
Smiling faces (virtual or in-person) are the norm around here. We enjoy a friendly work environment where everyone is dedicated to mutual trust, respect, and excellence.Thank you for your interest in Telligen!Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed.Telligen and our affiliates are Affirmative Action, Equal Opportunity Employers (EOE/M/F/Vet/Disability), and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. Telligen does not accept 3rd party solicitations from outside staffing firms.#J-18808-Ljbffr Recommended Skills Account Management Business Development Business Efficiency Business Process Improvement Clinical Works Coaching And Mentoring Apply to this job. Think you're the perfect candidate? Apply on company site $(document).ready( function() $(#ads-desktop-placeholder).html(
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n Estimated Salary: $20 to $28 per hour based on qualifications.
years experience working with Medicaid, government health plans, or authorization programs in the healthcare environment; including some prior authorization, utilization management (UM), care management, and/or healthcare quality improvement 3
years managing projects and/or professional clinical and non-clinical staff Background in operations, operational efficiency, and KPI's Demonstrated experience working in a fast-paced and deadline-driven environment Knowledge of State and Federal rules and regulations that drive UM process and scope of work. Must be located in the State of Mississippi Must be able to report to the local office daily. This is not a remote position. We are unable to consider candidates outside of the United States, candidates in the state of California, or those in US Minor outlying islands and territories. COMMITMENT TO SAFETYAs part of our commitment to health and safety,some roles may require additional health protocols (i.e. personal protective equipment or vaccination)Who We Are:
Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise.Health has changed a lot through our 50-year history, but what has remained constant is that we care deeply about who we serve and what we do. Our success is built on our ability to adapt, respond to client needs, and offer innovative solutions.Our business is our people and we're looking for talented individuals who not only believe in our mission but who are ready to take ownership and make a difference in the lives of people, in the world of health. Learn more about who we are and what we do atwww.telligen.com/about-usAre you Ready?We're on a mission to transform lives and economies by improving health and getting there means following through on our values of Ownership, Community, Ingenuity & Integrity.Ownership:
As a 100% employee-owned company, our employee-owners drive our business, our solutions, and share in our success. When employee-owners grow and thrive, we all win.Community:
Putting others first and being a good corporate partner wherever we work, and play makes us who we are. We Show Up. For our clients, for our communities, and for each other.Ingenuity:
We're a team of passionate professionals driven by hard work and big ideas. We understand that high-value breakthroughs come from taking calculated risks. If it will benefit our clients and advance our mission, we're all ears. We celebrate free-thinking and challenge the status quo, so brainstorm away!Integrity:
Smiling faces (virtual or in-person) are the norm around here. We enjoy a friendly work environment where everyone is dedicated to mutual trust, respect, and excellence.Thank you for your interest in Telligen!Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed.Telligen and our affiliates are Affirmative Action, Equal Opportunity Employers (EOE/M/F/Vet/Disability), and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. Telligen does not accept 3rd party solicitations from outside staffing firms.#J-18808-Ljbffr Recommended Skills Account Management Business Development Business Efficiency Business Process Improvement Clinical Works Coaching And Mentoring Apply to this job. Think you're the perfect candidate? Apply on company site $(document).ready( function() $(#ads-desktop-placeholder).html(
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n Estimated Salary: $20 to $28 per hour based on qualifications.
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