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)
Marian Regional Medical Center a 191-bed facility located in Santa Maria California is recognized as one of the Top 250 Hospitals in the Nation by Healthgrades and was awarded Best Maternity Care by Newsweek. It ranks among 10% in the nation for safety core measures in cardiac services and has the only comprehensive cancer treatment and resource program from Los Angeles to San Francisco. Marian’s beautiful mission-style facility houses the latest technology to support excellent physicians and caregivers who deliver compassionate care each and every day. Marian Regional Medical Center is a part of Dignity Health’s Southwest Division and is a member of CommonSpirit Health the largest not-for-profit health care system in the nation boasting an integrated network of top quality hospitals with physicians from the most prestigious medical schools and comprehensive outpatient services - all recognized for quality safety and service. Marians offers Santa Maria Valley residents access to the most advanced technologies an expanded and enhanced Emergency Department Critical Care Unit neonatal intensive care unit and an array of womens services.
Provides leadership, direction and clinical and operational supervision of patient care for Pre & Post Surgery. Demonstrates responsibility for quality and care management improvement initiatives and implementation and maintenance of standards. Acts as the leader and role model for professional practice conducted in the areas under their supervision and demonstrates responsibility for standards development and staff education.
Minimum Qualifications:
Please be advised that this location requires quarterly American Heart Association (AHA) Resuscitation Quality Improvement (RQI) competency certification post-hire. This ongoing competency is required through resources internal to the facility; outside RQI competency resources are not acceptable for CommonSpirit Health compliance requirements.
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