Description and Requirements
Regulatory Compliance:
- Ensure adherence to regulatory initiatives and requirements, actively participating in relevant meetings as assigned.
Documentation Management:
- Maintain Job Aides and Policies & Procedures, updating them in response to changes or new regulatory mandates, products, or processes.
Project Oversight:
- Oversee team and departmental projects, diligently managing timelines to meet established deadlines.
Collaboration:
- Collaborate closely with Care Management and Utilization Management teams on network requests, identifying root causes and offering strategic solutions to mitigate challenges.
Network Analysis:
- Analyze provider networks to verify compliance with Health Plan Network (HPN) State Requirements, ensuring alignment with organizational objectives.
Reporting:
- Develop and maintain a variety of reports, including daily, weekly, monthly, quarterly, and ad hoc reports, to provide insights into business unit performance.
Solution Recommendations:
- Offer recommendations for addressing deficiencies identified during analysis, taking ownership of implementing solutions.
Presentation Preparation:
- Prepare compelling PowerPoint presentations as needed to communicate project updates, findings, and recommendations effectively.
Additional Responsibilities:
- Undertake any additional duties as assigned, demonstrating flexibility and adaptability in fulfilling organizational needs.
Minimum Qualifications:
- High School Diploma or GED from accredited school.
- Bachelor’s degree in a relevant field; advanced degree preferred.
- 5 years of experience in project management or a related field, preferably in the healthcare sector.
- Strong understanding of regulatory requirements and compliance frameworks.
- Excellent communication, collaboration, and problem-solving skills.
- Proficiency in Microsoft Office Suite, particularly PowerPoint and Excel.
- Ability to thrive in a fast-paced, dynamic environment while maintaining attention to detail.
- Proven ability to prioritize tasks and manage multiple projects simultaneously.
Preferred Qualifications:
- Associate’s degree
Hiring Range*:
Greater New York City Area (NY, NJ, CT residents): $81,100 - $117,470
All Other Locations (within approved locations): $71,600 - $106,505
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.