Medical Policy Manager jobs in Nevada

Description

Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Providence Health Plan is calling a Manager Coding Policy who will:

• Be responsible for the management and supervision of all Coding Policy development, quality, implementation, publication, and interim or routine update
• Coordinate, manage, and direct all aspects of the Plan's policy life cycle
• Ensure all coding, regulatory, legal, and operational practices are maintained, consistent, and documented
• Manage certified Coding Policy Analysts and all coding-related reviews, work queues, and analyst metrics
• Ensure appropriate review and payment of coding related claims in a timely fashion across all lines of business
• Be responsible for identification and operationalization of new coding review initiatives, driving toward new opportunities to implement appropriate coding UM controls
• Be responsible for building and maintaining strategic internal and external relationships as they relate to the administration and operationalization of coding policies for all lines of business, clients, and business partners
• Be responsible for complex projects, including oversight of the coding policy edits in the claim editing system to ensure consistent and accurate adjudication of claims
• Represent the Coding Policy Team and related work in high-profile leadership meetings, ensuring thorough communication of policy changes and related impacts, including data analysis, to internal and external stakeholders
• Be responsible for creating and maintaining strategic partnerships and using superior leadership and management skills to translate related policy changes to meet Plan department and team needs
• Be responsible for ensuring all Coding Policy changes and updates are vetted through appropriate review structure and committee meetings prior to implementation
• Be responsible for routine presentations regarding all financial business opportunities and strategic process improvements which result in team growth, savings, and quality
• Be responsible for setting Coding Policy Team strategic goals, ensuring team collaboration, and provide coaching and mentorship to ensure alignment with Department and Plan vision and mission

We welcome 100% remote work for residents who reside in one of the following States:

• Alaska
• Washington
• Oregon
• Montana
• California
• Nevada
• New Mexico
• Texas

Required qualifications for this position include:

• Bachelor's Degree in Business Administration, Healthcare Administration, or a closely related field of study
• Certified Professional Coders Certificate
• 5 years of related experience working in or with a managed care or health care organization
• 5 years of Clinical Coding experience, preferable in a payer setting
• 3 years of experience with CMS, Medicaid and State(s) regulatory requirements and quality accreditation bodies - NCQA and/or URAC
• 5 years of leadership experience
• 3 years of experience in technical policy & procedure writing as it relates to regulatory and accreditation standards

Preferred qualifications for this position include:

• Master's Degree in Healthcare Administration, Public Health, Business Administration or related field
• Coursework/Training: Training in one or more of the following: Lean, Agile, six Sigma and Change Acceleration Process (CAP)
• Internal auditing & monitoring principles

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

About the Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Requsition ID: 270900

Company: Providence Jobs

Job Category: Coding

Job Function: Revenue Cycle

Job Schedule: Full time

Job Shift: Day

Career Track: Leadership

Department: 5018 HCS MEDICAL MANAGEMENT OR REGION

Address: OR Beaverton 3601 SW Murray Blvd

Work Location: Murray Business Ctr Beaverton-Beaverton

Pay Range: $47.33 - $76.19

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.