Job Description

Job Summary:

The Medical Affairs Operations Manager is responsible for supporting the standardization, management of data, and workflow optimization for the Medical Affairs team. This role will function as a central hub to triage, prioritize, and manage operational workflow challenges, including data reporting standardization and technology implementation.


Essential Functions:

• Partner with Medical Affairs leaders to enhance productivity and ensure alignment with company objectives.
• Oversee the long term tracking and trending of high priority items, including automated prior authorization processes, market reviews related to high utilization and/or cost, and process improvement/automation in appeals, clinical policy and quality of care.
• Manage and report on productivity and performance metrics, including MD and vendor auditing.
• Develop consistent and standardized reporting across all teams for regular updates to senior leadership.
• Investigate and analyze issues identified by leaders through data, focusing on state complaints and concerns.
• Support Key Performance Indicators (KPI) review for potential Quality and Affordability Initiative (QAI) projects.
• Track project timelines and develop a comprehensive tracker to manage, communicate, and organize all ongoing projects.
• Facilitate multidisciplinary and cross departmental collaboration for project management and QAI development.
• Focus on optimization initiatives, including AI applications, workflow enhancements, automated documentation, and standardized data reporting.
• Lead routine meetings to ensure alignment and progress on projects.
• Develop tools to improve efficiency and automate tasks to avoid manual data entry.
• Develop centralized educational sessions for front line MD, Appeal MD, and nursing teams.
• Gather information for vendor Requests for Proposals (RFPs).
• Represent Medical Affairs in the implementation and integration of new business initiatives.
• Perform any other job related duties as requested.

Education and Experience:

• Bachelor's degree in healthcare administration, nursing, or a related field required
• Master's degree preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Five (5) years project management experience in a healthcare setting required

Competencies, Knowledge and Skills:

• Skilled in project management, data analysis, and operational workflow optimization
• Strong analytical skills with the ability to interpret complex data and identify trends
• Excellent communication and interpersonal skills
• Proficient in project management tools and data reporting software
• Ability to work independently and manage multiple projects simultaneously

Licensure and Certification:

• Current unrestricted license as and Registered Nurse (RN) or Nurse Practitioner (NP) required
• MCG certification is required or must be obtained within 6 months of hire required
• Project Management certification preferred
• Six Sigma or other certification in process improvement preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Up to 15% (occasional) travel based on the needs of the department may be required

Compensation Range:
$83,000.00 - $132,800.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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Job Tags

Work experience placement, Work at office

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