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)
POSITION SUMMARY:
The Human Resources (HR) Business Partner provides consultative support for workforce issues that impact the overall operational strategy for the core business functions of the organization and the assigned client groups. The HR Business Partner serves as the primary point of contact to leaders related to human resource management, policies, procedures, employment law and fundamentals of all core areas of human resources and ensures ease of access to HR deliverables for clients. Specific consultative services that the HR Business Partner will provide include:
Counsel and support in all areas of human resource management including staffing and retention, employee engagement, workforce safety, employee relations, talent planning, performance management, compensation, benefits, equal employment opportunity, affirmative action, organizational development, and compliance with employment and regulatory requirements. The HR Business Partner will call upon subject-matter experts within HR to meet client needs as deeper analysis and support is needed.
 Consult and work with client group leadership to resolve human resources related issues and concerns impacting the work environment and a just culture for all staff.
 Develop strong and supportive relationships with key operational leaders.
EDUCATION/TRAINING:
Bachelor’s Degree in Business, Human Resources or related field required. Master’s Degree preferred.
At least five years of progressively more responsible experience in Human Resources.
Three (3) – five (5) three years of experience in an Employee Relations position preferred.
LICENSURE/CERTIFICATION:
PHR/SPHR/SHRM – CP/SHRM - SCP designations are highly desirable.
EXPERIENCE/SKILLS/ABILITIES:
Familiarity with Human Resources policies and procedures and applicable Federal and State laws and regulations. Full understanding of all HR functions and best practices, and a thorough knowledge of labor legislation. Possesses demonstrable experience in HR metrics. Proficient in a variety of computer applications. Excellent communication, planning, conflict management, organization and critical thinking/decision making skills required. Strong interpersonal skills and ability to interact with all levels of staff within the organization and resources within the community. Successful completion of annual job specific competencies and skill verification tools required.
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