• Program Operations Manager

    Job Locations US-SC-Columbia
    # of Openings
  • Overview

    Summary: The Program Operations Manager shall participate in the collaborative responsibilities of day to day non-clinical management of the SCS MCCW program. This position shall be the primary point of contact for CHS/corporate departments of credentialing and finance (regarding the physician network), SC physicians/providers, SCS Credentialing Committee and USC School of Medicine. This position shall be responsible for supporting the Management Team in the ongoing monitoring and managing of all program deliverables and appropriate escalation of issues for resolution to the CHS Chief Medical Officer.


    Essential Duties and Responsibilities:

    1. Act as secondary SCS liaison with SCDHHS
      1. Participates, or coordinates participation in regular meetings, at minimum quarterly, with SCDHHS to review program performance.
      2. Participates, or coordinates participation in calls on a monthly basis, at minimum, to address outstanding program contract, billing, or administrative issues.
      3. Attend all SCDHHS scheduled meetings on behalf of SCS/CHS.
      4. Address nonclinical issues brought to SCS/CHS attention by SCDHHS.
      5. Collaborate with Clinical Nurse Manager and Administrative Coordinator to provide detailed monthly summary to Executive Director for State Programs of contacts and meetings- topics, decisions, action items with responsible parties and deadlines. 
    1. Act as SCS liaison with corporate office
      1. Participates, or coordinates the participation of regular meetings, at minimum monthly, with credentialing, compliance/quality, finance, and other departments as needed to to discuss/review program updates and issues
        1. Collaborate with Administrative Coordinator on detailed summary to CHS Chief Medical Officer of meetings- topics, decisions, actions items with responsible parties and deadlines
    1. Act as primary liaison for USC School of Medicine
      1. Schedule quarterly meetings, at minimum, with the MCCW Medical Director or CHS Chief Medical Officer to review program performance and address outstanding issues
    2. Act as primary liaison for all MCCW providers and potential providers
      1. Maintain and expand Physician network to promote access and availability of MCCW services.
      2. Educate providers, staff, and community stakeholders about benefits of MCCW participation.
      3. Define and ensure compliance with Appendix C or contract development related to physician network and enroll interested providers to expand MCCW services.
      4. Support provider contracting and enrollment through assistance to CHS staff responsible for credentialing and re-credentialing
        1. Contact provider offices to secure any needed credentialing materials
        2. Accurately process Provider add/change forms to SCDHHS
      5. Act as primary point of contact for MCCW providers
        1. Contact provider offices or other entities on behalf of provider offices to follow up on identified complaints or concerns- to include assisting provider with claims issues or eligibility issues
        2. Ongoing development of Provider Manual and correlating Policies and Procedures related to Physician Network. 
    1. Act as Operations Coordinator for the MCCW program
      1. Provide guidance and support to the allMCCW Staff with regard to non-clinical issues (productivity, compliance with contract requirements and corporate policies, attendance)
        1. Care Coordinators
        2. Care Advocates
        3. Clinical Manager
        4. Resource Nurse
        5. Administrative Coordinator
        6. CHS Staff 
      2. Collaborate with Administrative Coordinator CHS Chief Medical Officer, and other SCS Staff members on development and implementation of an Annual Growth Plan with established goals for:
        1. Financial viability
        2. Sustainability
        3. Program expansion
        4. Compliance performance
        5. Quality of care
      3. Provide qualitative research and quantitative reporting to support all process improvement efforts in addition to updates on annual plan and progress toward meeting goals
      4. Escalate issues, as appropriate, to CHS Chief Medical Officer
      5. Will have access and manage PHI in accordance with Federal and State requirements (HIPAA, HITEC).


    Other Responsibilities:

    • Adheres to the policies and procedures of Community Health Solutions of America, Inc.
    • Maintains strict confidentiality of client, company and personnel information
    • Demonstrates a strong commitment to the mission and values of the organization
    • Adheres to company attendance standards
    • Performs other duties and ad hoc reporting as needed or assigned
    • Healthicity Application maintenance?


    Supervisory Responsibilities:   None



    • Strong organizational and interpersonal skills
    • Excellent written and verbal communication skills
    • Detail oriented
    • Ability to multi-task and work independently




    Education and/or Experience:

    Bachelor’s degree required (Masters preferred) plus two years’ experience in a health related position.


    Certificates, Licenses, Registrations:


    Computer Skills:

    Proficiency using software programs such as MS Word, PowerPoint, Excel and Outlook                                        


    Environmental Factors/Physical Demands:


    Work is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds.


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