Medical Policy Manager manages and implements corporate policy and process for medical provider and other reimbursements. Ensures that all claims are reviewed, settled, and processed in compliance with and according to contract provisions and regulatory requirements. Being a Medical Policy Manager evaluates and develops policies and provider reimbursement guidelines to effectively manage and control medical claims cost. Requires a bachelor's degree of finance, business or healthcare administration. Additionally, Medical Policy Manager typically reports to head of a unit/department. The Medical Policy Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Policy Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
St. Luke’s Health–Brazosport Hospital is located on a beautiful 25-acre campus in Lake Jackson Texas. Offering state-of-the-art diagnostic and comprehensive treatment services our hospital is home to a 154-bed patient tower level III trauma center advanced cardiac care center and full-service multidisciplinary cancer center. Our team consists of over 100 board-certified physicians and nearly 600 highly skilled employees to meet our patients’ medical needs. South Brazoria County’s premier healthcare system St. Luke’s Health–Brazosport Hospital is dedicated to providing quality care with compassion for the communities we serve.
Provides accountability for the delivery of quality patient care that promotes the safety and well-being of all patients on assigned units. Responsible for planning, prioritizing, organizing, directing and meeting the daily needs and demands of patients and staff on assigned nursing units. Uses sound knowledge of nursing practices to assign patient care responsibilities to staff based on the patient’s acuity and skill needs. Operationalizes knowledge of human resourcemanagement to effectively manage and communicate with staff on assigned unit to promote open communication, teamwork and enhanced work performance. Responsible for effective utilization to ensure appropriate and efficient useof financial, supply and staff resources. Accountable for unit-level implementation of hospital policies and procedures. Achieves high productivity while attaining exceptional patient, physician and associate satisfaction. This positionrequires a sound knowledge of nursing practice and exceptional leadership abilities to manage complex, stressful and critically important environments. Promotes mission, vision and purpose.
- Demonstrates the ability to progressively guide and lead groups of people to meet goals and exceed customer requirements. Role models leadership behavior and collaborative team relationships.- Assists with creating team based quality improvement plans, including definition of team goals, utilizing performance measures and appropriate analysis tools, changing and improving performance through feedback, coaching and teaching. Leads the patient care unit in care delivery based on research findings and evidence-based practice.- Monitors volume trends incorporating financial and customer satisfaction measures. Demonstrates an ability to plan, organize, and control department resources and communicate fiscal expectations to staff.- Demonstrates the ability and dedication to address issues and activities that encompass the larger aspect operations of the facility including the ability to communicate with other members of the facility such as physicians, staff and external sources/vendors. Maintains an effective channel for productive and interactive communication.- Participate on committees and leads projects as assigned.
Required Education and Experience:
Bachelor’s degree in nursing (BSN)
Minimum of 3 years of clinical leadership experience; or 5 years of leadership experience in the discipline; or Master's Degree and no experience
Required Licensure & Certifications:
• Registered Nurse the state of Texas (RN:TX)• BLS
Required Skills, Abilities and Training:
Demonstrated ability to problem solve and be supportive/innovative in the process of change; strong human relations skills with an ability to handle difficult/sensitive issues with regard to patient confidentiality; ability to motivate others; and excellent written/oral communication skills; knowledge of hospital practices and procedures, as well as laws, regulations, and guidelines pertaining to the department. Service Skills: An ability to integrate and interpret data from diverse sources addressing issues high complexity. An ability to develop strong relationships with customers (i.e. patients, physicians and supporting departments).
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