Jobs and Careers at the U.S. Medical Management Talent Network

Program Manager - Specialty Programs

Department: Specialty Programs
Location: Troy, MI
Company: USMM

Program Manager - Specialty Programs

U.S. Medical Management (USMM), an affiliate of a leading Fortune 250 company, manages a nationwide continuum of premier providers of medical services delivered primarily to the homes of elderly and home-bound patients. Providing primary home care is the future of medicine, and at USMM, the future is now. With the knowledge and experience to address the evolution of healthcare, USMM is poised for a phenomenal future.

Position Description

The Program Manager - Specialty Programs is responsible for the day-to-day program support for all In Home Assessment programs (IHA) and Specialty Programs.  These activities include, (not inclusively) program implementations, coordination of operational cross-departmental initiatives within USMM and Centene, research/presentations to support current and growth businesses tied to Specialty Programs.   Act as the interface between USMM business units, IT technical staff and corporate partners while providing operational support to all specialty programs.

 

Essential Duties and responsibilities

  • Daily program management throughout the program life cycle and end-to-end processes, including program governance, resources, tasks, deadlines, etc.

  • Manage the complete implementation and ongoing monitoring of IHA initiatives, such as:

    • Community Health Services

    • Telehealth

    • Mobile Clinics

    • Email/Text Campaigns

    • Other Specialty Program Initiatives

  • Manage program requirements confirming vendors comply with Centene approved file formats and reconcile receipt of timely IHA vendor file submissions, including (but not limited too):

    • Disposition Reports

    • Lab Files

    • Hedis Non-Lab Files

    • Charge Files

    • Urgent Case Management Referrals

    • Non-Urgent Case Management Referrals

    • PDF Assessment Summaries

    • PDF Assessment crosswalk/inventory

    • Capacity

    • Forecast

    • Other Specialty Program reports

  • Manage, report, respond to ongoing vendor monitoring, including:

    • Call Monitoring Audits

    • Quarterly Coding Audits

      • Complete 5% internally

      • Completed by Centene

    • Vendor SLAs

  • Manage validation and reconciliation process for all vendor invoices

  • Manage the successful process for automatic file transfers between Centene, USMM and IHA Vendors for all IHA files.  Notifying the Specialty Program Business Analyst and/or MCO Specialist to resolve any issues.

  • Track all Centene Outreach, Gap, Diagnosis, and Supplemental Data files, ensuring information is accurate and assigned correctly.

  • Respond to Ad Hoc requests from Health Plans and Centene concerning IHA or Specialty Programs.

  • Coordinate all vendor weekly meetings, capturing minutes, action items and outcomes.

  • Be the interface between USMM business units, IT technical staff and Centene corporate partners

  • Other duties as assigned

 

REQUIRED Knowledge, Skills and Experience

  • 5+ years of management experience in health care organization

  • Strong organizational, communication and leadership skills

  • Must be able to relate professionally and positively to clients, providers and internal leadership with excellent communication, interpersonal and management skills

  • Proficient in all Microsoft Office products

 

preferred Knowledge, Skills and Experience

  • BA/BS degree in Business Administration, Management, or a clinical discipline
  • Previous Risk Adjustment experience

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