Regional General Manager
Pair TeamSalary not specified
- Full Time
- Expert & Leadership (9+ years)
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
Candidates must possess an active Registered Nurse (RN) license in a state participating in the enhance licensure (eNLC) without disciplinary action, and a minimum of two years of experience in prior authorization, utilization management, or a related field. A minimum of two years of experience as a Team Lead, Subject Matter Expert, or Project Leadership, or Charge Nurse is also required, along with knowledge of Medicaid policies and procedures, payer policies, insurance companies, and government health programs.
Responsibilities
The Manager of National Medicaid Clinical Operations will oversee the hiring, training, and development of clinical and nonclinical staff, conduct regular performance evaluations, and provide coaching and mentoring. They will manage the day-to-day operations of clinical and nonclinical services, develop and implement policies and procedures, ensure compliance with regulatory and accreditation requirements, implement quality assurance measures, conduct audits, and promote intradepartmental and cross-market coordination. The role also involves conducting data analysis to identify trends, optimizing workflows, implementing quality improvement initiatives, assisting in strategic planning, and liaising with healthcare providers, payers, and other stakeholders.
Skills
Staff Management
Performance Evaluation
Policy Development
Regulatory Compliance
Quality Assurance
Auditing
Data Analysis
Workflow Optimization
Stakeholder Collaboration
Humana
Health insurance provider for seniors and military
About Humana
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.
Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees