Independent Review Organization Assistant Director of Operations (On-site)
Nexmc, San Antonio, TX, United States
Description
The
Assistant Director of Operations
works closely with the Director of Operations and VP of Operations to ensure the organization is well positioned in a rapidly evolving and competitive environment by being an agent for ongoing organizational change. The position is responsible for the management and oversight of the Intake, Fulfillment, and QA Nurse departments. Additionally, this position is responsible for the processes and functions of the daily administrative workflow efficiencies for ProPeer. This person also oversees daily operations, which include supervising the operational team performing all aspects of UR and IRO business lines. The goal is to achieve clinical, financial, and utilization goals through effective management, communication, and role modeling. The role is responsible for carrying out assignments in a manner to ensure success in financial management, human resources management, leadership, quality, and operational management objectives. The role participates in program development and unit performance improvement. The role consistently demonstrates the core values of ProPeer and serves as a role model to other team members.
Essential Job Functions
Supervises and directs the workload of the IRO
Responsible for workflow and production expectations
Reviews performance against operating plans and standards. Provides reports to subordinates with interpretation of results and approves changes in direction of plans
Ensures that the Quality Assurance Nurse department completes client-specified work according to the client specifications
Presents monthly reports on performance as requested by the Executive Vice President
Develops and presents to the Executive Vice President matters requiring a decision outside of their authorization level
Develop and recommend objectives in each area of Operations
Clinical account management that results in top-notch client service, as well as a positive work environment, fostering a pattern of long-term staff retention
Develop specific short-term and long-term plans, processes, and programs, together with supporting budget requests and financial estimates
Coordinates and collaborates with other departments of the organization in establishing and carrying out responsibilities
Reviews operational projects involving major functional changes within the organization’s functional areas and creates change management plans for approval by the Executive Vice President
Develop plans for new areas of technology for the operational functions, along with sufficient planning for areas that support the mission of the organization within Operations
Establishes objectives and processes governing the performance of assigned activities
Conducts URAC audits in conjunction with the Compliance Director
Selects and maintains qualified personnel in all positions reporting to Operations and provides the necessary coordination between activities
Identifies training needs, initiates development of subordinates, and recommends effective personnel action
Participates in the development and management of department budgets and productivity targets
Manages human resources utilization, promotes employee satisfaction, supports staff development, and utilizes the progressive discipline process when appropriate
Ensure that workflow operations complete client-specified work according to the client specifications
Participate in quality improvement processes and ensure implementation of regulatory standards
Oversee and mediate interdepartmental problems/issues, take corrective action promptly, and also promote respectful, responsive communication between departments
Establishes, evaluates, and monitors UR processes, policies, and procedures
Support company and departmental QA/QI initiatives and IRR initiatives
Performance monitoring of all team members
Produces production and quality reports for each month
Works in coordination with the AVP of Clinical Operations in the development of Nurse educational programs
Maintains appropriate communications within areas of responsibility
Keeps subordinates/employees informed as to the organization’s plans and progress
Consults with all segments of management responsible for policy or action
Ensures compliance within the assigned area of responsibility
Make recommendations for improving the effectiveness of policies and procedures
Submits budget for assigned activities in accordance with the budget procedure
Provides orientation and on-the-job training for subordinates and ensures that the authority and responsibility for each position are defined and understood
Ensure that the duties, responsibilities, authority, and accountability of all direct subordinates are defined and understood
Assumes other activities and responsibilities from time to time as directed
Requirements
Demonstrates ability to independently identify and define potential and/or current issues of concern, collect and analyze data, establish facts, draw valid conclusions, and exercise discretion and sound judgment
Will have knowledge of or ability to learn financial management related to UM/IRO function and reporting, quality improvement processes, and human resources management
Will be able to effectively monitor, evaluate, and administer the resources of each assigned area and make substantiated recommendations regarding resource allocation needs for future planning purposes
Ability to identify trends through analysis of practices to improve the overall utilization of resources and cost containment
Ability to communicate those trends found through analytical study using a variety of reporting mediums
Proven ability to recruit, train, and motivate personnel to balance staffing strength with profitability and growth
Ability to make recommendations for organizational changes to improve the UM/IRO efforts of the organization
Ability to represent UM/IRO in organizational committees as assigned
Excellent relationship management skills, including a high degree of professional demeanor and non-aggressive assertiveness
Demonstrated ability to problem-solve complex, multifaceted situations
Ability to engage easily in abstract thought
Strong organizational and task prioritization skills
Strong analytical, numerical, and reasoning abilities
Participative management style (advocates team concept)
Well-developed interpersonal skills. Ability to get along with diverse personalities. Tactful, mature.
Ability to establish credibility and be decisive – but able to recognize and support the organization’s preferences and priorities
Results-oriented with the ability to balance other business considerations
Knowledge of URAC Comprehensive IRO Policies and State/Federal External review regulations
Ability to construct grammatically correct documents using standard medical terminology when necessary
Computer literacy utilizing Microsoft Office products and database programs
Ability to travel for various meetings (clients and company)
Education and Experience
Bachelor’s Degree preferred
Minimum of 3 years upper management
License and Certification N/A
Driving Essential No
Position Demands This position requires sitting, bending, and stooping for up to 8 hours per day in an office setting. Ability to lift and move objects weighing up to 10 lbs. Ability to learn technical material. The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc. Must be able to operate a computer and other office productivity machinery such as a calculator, copy machine, printer, etc. The person in this position frequently communicates with guests, team members, and vendors and must be able to exchange accurate information.
Equal Employment Opportunity The Company is a veteran-owned Company and provides Equal Employment Opportunities (EEO) to all Team Members and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender (including gender identity), pregnancy, childbirth, or a medical condition related to pregnancy or childbirth, national origin, age, disability, genetic information, status as a covered veteran in accordance with applicable federal, state, and local laws, or any other characteristic or class protected by law and is committed to providing equal employment opportunities. The Company complies with applicable state and local laws governing non-discrimination in employment. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, promotion, discharge, pay, fringe benefits, membership, job training, classification, and other aspects of employment. Team Members who believe they are the victims of discrimination should immediately report the concern to their Supervisor and the Human Resources Department. Discrimination and harassment will not be tolerated.
We are committed to creating an inclusive environment for all Team Members and applicants. We value the unique skills and experiences that veterans bring to our team and encourage veterans to apply.
Disclaimer The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of our personnel. All company team members may be required to perform duties outside of their normal responsibilities from time to time, as needed.
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The
Assistant Director of Operations
works closely with the Director of Operations and VP of Operations to ensure the organization is well positioned in a rapidly evolving and competitive environment by being an agent for ongoing organizational change. The position is responsible for the management and oversight of the Intake, Fulfillment, and QA Nurse departments. Additionally, this position is responsible for the processes and functions of the daily administrative workflow efficiencies for ProPeer. This person also oversees daily operations, which include supervising the operational team performing all aspects of UR and IRO business lines. The goal is to achieve clinical, financial, and utilization goals through effective management, communication, and role modeling. The role is responsible for carrying out assignments in a manner to ensure success in financial management, human resources management, leadership, quality, and operational management objectives. The role participates in program development and unit performance improvement. The role consistently demonstrates the core values of ProPeer and serves as a role model to other team members.
Essential Job Functions
Supervises and directs the workload of the IRO
Responsible for workflow and production expectations
Reviews performance against operating plans and standards. Provides reports to subordinates with interpretation of results and approves changes in direction of plans
Ensures that the Quality Assurance Nurse department completes client-specified work according to the client specifications
Presents monthly reports on performance as requested by the Executive Vice President
Develops and presents to the Executive Vice President matters requiring a decision outside of their authorization level
Develop and recommend objectives in each area of Operations
Clinical account management that results in top-notch client service, as well as a positive work environment, fostering a pattern of long-term staff retention
Develop specific short-term and long-term plans, processes, and programs, together with supporting budget requests and financial estimates
Coordinates and collaborates with other departments of the organization in establishing and carrying out responsibilities
Reviews operational projects involving major functional changes within the organization’s functional areas and creates change management plans for approval by the Executive Vice President
Develop plans for new areas of technology for the operational functions, along with sufficient planning for areas that support the mission of the organization within Operations
Establishes objectives and processes governing the performance of assigned activities
Conducts URAC audits in conjunction with the Compliance Director
Selects and maintains qualified personnel in all positions reporting to Operations and provides the necessary coordination between activities
Identifies training needs, initiates development of subordinates, and recommends effective personnel action
Participates in the development and management of department budgets and productivity targets
Manages human resources utilization, promotes employee satisfaction, supports staff development, and utilizes the progressive discipline process when appropriate
Ensure that workflow operations complete client-specified work according to the client specifications
Participate in quality improvement processes and ensure implementation of regulatory standards
Oversee and mediate interdepartmental problems/issues, take corrective action promptly, and also promote respectful, responsive communication between departments
Establishes, evaluates, and monitors UR processes, policies, and procedures
Support company and departmental QA/QI initiatives and IRR initiatives
Performance monitoring of all team members
Produces production and quality reports for each month
Works in coordination with the AVP of Clinical Operations in the development of Nurse educational programs
Maintains appropriate communications within areas of responsibility
Keeps subordinates/employees informed as to the organization’s plans and progress
Consults with all segments of management responsible for policy or action
Ensures compliance within the assigned area of responsibility
Make recommendations for improving the effectiveness of policies and procedures
Submits budget for assigned activities in accordance with the budget procedure
Provides orientation and on-the-job training for subordinates and ensures that the authority and responsibility for each position are defined and understood
Ensure that the duties, responsibilities, authority, and accountability of all direct subordinates are defined and understood
Assumes other activities and responsibilities from time to time as directed
Requirements
Demonstrates ability to independently identify and define potential and/or current issues of concern, collect and analyze data, establish facts, draw valid conclusions, and exercise discretion and sound judgment
Will have knowledge of or ability to learn financial management related to UM/IRO function and reporting, quality improvement processes, and human resources management
Will be able to effectively monitor, evaluate, and administer the resources of each assigned area and make substantiated recommendations regarding resource allocation needs for future planning purposes
Ability to identify trends through analysis of practices to improve the overall utilization of resources and cost containment
Ability to communicate those trends found through analytical study using a variety of reporting mediums
Proven ability to recruit, train, and motivate personnel to balance staffing strength with profitability and growth
Ability to make recommendations for organizational changes to improve the UM/IRO efforts of the organization
Ability to represent UM/IRO in organizational committees as assigned
Excellent relationship management skills, including a high degree of professional demeanor and non-aggressive assertiveness
Demonstrated ability to problem-solve complex, multifaceted situations
Ability to engage easily in abstract thought
Strong organizational and task prioritization skills
Strong analytical, numerical, and reasoning abilities
Participative management style (advocates team concept)
Well-developed interpersonal skills. Ability to get along with diverse personalities. Tactful, mature.
Ability to establish credibility and be decisive – but able to recognize and support the organization’s preferences and priorities
Results-oriented with the ability to balance other business considerations
Knowledge of URAC Comprehensive IRO Policies and State/Federal External review regulations
Ability to construct grammatically correct documents using standard medical terminology when necessary
Computer literacy utilizing Microsoft Office products and database programs
Ability to travel for various meetings (clients and company)
Education and Experience
Bachelor’s Degree preferred
Minimum of 3 years upper management
License and Certification N/A
Driving Essential No
Position Demands This position requires sitting, bending, and stooping for up to 8 hours per day in an office setting. Ability to lift and move objects weighing up to 10 lbs. Ability to learn technical material. The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc. Must be able to operate a computer and other office productivity machinery such as a calculator, copy machine, printer, etc. The person in this position frequently communicates with guests, team members, and vendors and must be able to exchange accurate information.
Equal Employment Opportunity The Company is a veteran-owned Company and provides Equal Employment Opportunities (EEO) to all Team Members and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender (including gender identity), pregnancy, childbirth, or a medical condition related to pregnancy or childbirth, national origin, age, disability, genetic information, status as a covered veteran in accordance with applicable federal, state, and local laws, or any other characteristic or class protected by law and is committed to providing equal employment opportunities. The Company complies with applicable state and local laws governing non-discrimination in employment. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, promotion, discharge, pay, fringe benefits, membership, job training, classification, and other aspects of employment. Team Members who believe they are the victims of discrimination should immediately report the concern to their Supervisor and the Human Resources Department. Discrimination and harassment will not be tolerated.
We are committed to creating an inclusive environment for all Team Members and applicants. We value the unique skills and experiences that veterans bring to our team and encourage veterans to apply.
Disclaimer The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of our personnel. All company team members may be required to perform duties outside of their normal responsibilities from time to time, as needed.
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