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)
Description
Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.
Join our Center for Nursing Excellence team as we seek a dynamic and motivated Policy Manager!
In this role, you will oversee the organization's electronic policy system, guide end-users through the policy process and ensure compliance with internal and external regulatory standards. You will also play a key role in fostering a culture of evidence-based practice. Strong communication abilities, interpersonal skills, attention to detail and expertise with collaborating effectively with various stakeholders are essential for success in this role.
Responsibilities:
1.Policy Management – Oversees the organization’s electronic policy system, providing support to users throughout the policy process including development, regular review and interim assessments of policies, procedures, guidelines and related documents.
2.Technologies – Manages the organization’s electronic policy management system, liaison with vendors as necessary. Implements backup measures to mitigate technology failures.
3.Accreditation Compliance - Ensures that policies, procedures and associated documents meet or exceed internal and external regulatory standards. Responds to requests from accreditation bodies as it relates to policies, procedures, guidelines, standing orders and other documents.
4.Legal Collaboration – Works collaboratively with hospital attorneys and risk management to address and respond to legal requests pertaining to policies, procedures, guidelines and documents.
5.Evidence-Based Practice – Works collaboratively to ensure policies, procedures and guidelines reflect evidence-based standards of care.
6.Customer Satisfaction - Fosters high levels of customer satisfaction among both internal and external stakeholders by promptly addressing inquiries and serving as a resource for complex service and administrative matters. Interprets and communicates policies and procedures effectively based on organizational knowledge.
7.Educational Programs -Independently assesses needs, designs, develops, implements and evaluates educational programs for hospital employees with a focus on policy, procedure, guideline, standing orders and scope of service.
8.Planning -Develops strategic plan, goals, associated metrics and annual evaluation for the program.
9.Quality Improvement - Leads improvement efforts to maintain the quality of the policy, procedure, guideline and document process. Engages with interprofessional stakeholders to lead change.
10.Professional Growth and Development – Demonstrates responsibility for own professional growth and development. Maintains current certification in clinical specialty, leadership or Nursing Professional Development.
Legal Employer: STATE
Entity: UNC Medical Center
Organization Unit: Center of Nursing Excellence
Work Type: Full Time
Standard Hours Per Week: 40.00
Salary Range: $34.65 - $49.81 per hour (Hiring Range)
Pay offers are determined by experience and internal equity
Work Assignment Type: Onsite
Work Schedule: Day Job
Location of Job: US:NC:Chapel Hill
Exempt From Overtime: Exempt: Yes
This is a State position employed by UNC Health Care System.
Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.
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