Manager-Health Services Policy & Compliance (Remote)

American Specialty Health Incorporated (ASH) is seeking a Manager-Health Services Policy and Compliance to join our Health Services department.

The primary purpose of this position is to coordinate policy development and maintenance; to support accreditation, client, and regulatory compliance; and to coordinate activities that meet corporate goals in support of various departments.

Remote Worker Guidelines

• Remote Worker Guidelines: This position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network. The internet connection must have a consistent 50 down/10 up Mbps minimum internet speed. 100 down/20 up is recommended to support higher quality video meetings.

Responsibilities

• Coordinates operational projects and activities in support of corporate goals, regulatory requirements, and accreditation guidelines.
  • Complete annual review of assigned policies within established time frames.
  • Coordinates and manages the completion of all assigned and operational policy-related action items from workgroups, key process teams, and committees.
  • Assists with training policy team on processes and procedures.
  • Ensures policies align with accreditation and federal and state requirements.
  • Assists in identifying and tracking of accreditation standard revisions.
  • Develops and documents action plans and workflows for assigned projects.
  • Supports corporate quality improvement processes and works with various departments on quality improvement activities as assigned.
  • Assists with policy development and/or revisions to support client implementations, client audits, and corrective action plans.
  • Participates in committees, workgroups, and project teams as assigned.
  • Maintains confidentiality of all members, provider, client and proprietary information.
  • Supports Organizational compliance with QI policies and assists with HQI activities and QIA deliverables.
  • Supports external audits (regulatory, clients).
  • Demonstrate ability to work across the Health Services teams collaboratively and effectively and cross-functionally.
  • Responsible for leading teams; attending key meetings representing Health Services and delivering results.
  • Escalate cross-functional project barriers and issues in an effective and timely manner.
  • Provides reporting and supports department leadership, including the collection of information, project outcomes, and deliverables.
  • Deliver multi-faceted projects as assigned by department leadership and provide ad hoc support as requested.
• Assists with projects and activities in support of corporate goals, regulatory requirements, and accreditation guidelines.
  • Assists with special projects to support corporate goals.
  • Assists with regulatory audit and filings from policy support perspective.
  • Assists with creating standards crosswalks for URAC and NCQA.
  • Assists with collecting materials and completing accreditation applications.
  • Assist with supporting onsite accreditation audit.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Bachelor’s Degree required.
• Master’s Degree in Health Services Administration, Public Health, or related field preferred.
• 5 years of experience in health care administration. Knowledge of managed care operations, health plan delegation processes, accreditation guidelines, and quality assurance techniques required.
• Strong analytical, problem solving, verbal and written communication skills.
• Ability to complete objectives, strategies, and projects related to policy research and management, accreditation management, quality improvement, and other special projects, as assigned.
• Demonstrated strong research skills.
• Ability to read, interpret, and analyze documents; and demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
• Computer skills including word processing, Excel spreadsheets, databases, and email.
• Strong attention to detail.
• Ability to manage multiple priorities, deadlines, and cross-functional dependencies in a fast-paced environment.

Core Competencies

• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
• Ability to effectively organize, prioritize, multi-task and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions.
• Ability to exercise strict confidentiality in all matters.

Mobility

• Primarily sedentary, able to sit for long periods of time.

Physical Requirements

• Ability to see, speak, and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within and around the facility or Work from Home (WFH) environment. Capable of using a telephone, computer keyboard, and mouse. Ability to lift up to 10 lbs.

Environmental Conditions

• Work-from-home (WFH) environment.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law.

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.

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