Senior Manager, Clinical Quality Operations, CCS

Senior Manager, Clinical Quality Operations This Position is Remote We are more than just a healthcare company; we are a community of professionals driven by the knowledge that our success leads to a positive impact on the communities that we support. At ComplexCare Solutions, you’ll play a crucial part in innovating solutions that empower health plan members and healthcare providers alike. Our collaborative environment fosters creativity and initiative, ensuring that every idea and effort contributes to meaningful change in the industry. Join us and become a part of a team that turns vision into action, making a tangible impact on the future of healthcare. Duties and Responsibilities: Oversee and direct execution of the service delivery process across all Company product lines; Develop and implement operational policies, procedures, and strategies which enhance efficiency, customer service delivery capabilities, customer satisfaction, and ultimately enterprise value, through continuous improvement practices; Provide direct and active assistance to Director, Client Delivery Services to build and manage relationships with internal teams and key external partners to facilitate initiatives; Actively participation operational and implementation initiatives; Provide oversight of the Review Operations Managers and Lead Review Coordinators in their management of operational execution, product and service development and revision in conjunction with Manager of Regulatory Compliance, oversight of in-office operational staff in their execution of the delivery of CCS services and will provide direct and active assistance to Director in resolution of customer questions and service issues escalated by Client Project Managers or other personnel. Act as the operational liaison between the operational staff and other functional areas such as human resources, finance, and information systems, lead daily communication between Review Project Managers, Lead Review Coordinators and allocation of CCS staff resources. Collaborate with Director providing input for WFM headcount and projections to satisfy inventory demands; Act as a collaborative partner with the Director to manage and support team’s performance, development and training by assisting with and oversee the proper hiring, staffing, and training of operational staff in coordination with the Human Resources Business Partner (HRBP), and other cross functional teams necessary to process; Serve as product line expert regarding the CCS IHA, EF & SAPA process and the CCS HEDIS and CARA record review (non-clinical) process; Develop support service levels, deliverables, and reportable key service metrics results; while monitoring project progress and completion rates, and direct execution of CCS process in conjunction with Director to meet project deadlines across all LOB’s; and design and develop vendor management connections, integrations, and provider support model; Maintains constant communication with the team; and Identify and lead resolution of technical and non-technical problems which arise during the Operations processes. Maintain compliance with CCS’s policies, procedures and mission statement; Adhere to all confidentiality and HIPAA requirements as outlined within CCS’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position; and Fulfill those responsibilities and/or duties that may be reasonably provided by CCS for the purpose of achieving operational and financial success of the Company. Job Requirements: Minimum 5 years of experience, preferably in a call center management environment; Advanced knowledge of Microsoft Office applications including Excel and Outlook; Exceptional problem solving, analytical, interpersonal and communication skills to resolve issues within Operations; Professionally skilled in verbal and written communication; Meticulous organization skills, with the ability to multi-task; Ability to make sound decisions in a timely and independent manner; and Project management experience preferred. Travel for this position will include less than 10% locally for training and/or inventory purposes. Education: Bachelor's degree in business administration or related field; Active clinical license required; (RN or higher) preferred The company offers competitive compensation and an excellent benefits package. The Company is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, veteran status, or any other protected characteristic under federal, state, or other applicable laws. This company utilizes E-Verify