Medical Policy Manager manages and implements corporate policy and process for medical provider and other reimbursements. Ensures that all claims are reviewed, settled, and processed in compliance with and according to contract provisions and regulatory requirements. Being a Medical Policy Manager evaluates and develops policies and provider reimbursement guidelines to effectively manage and control medical claims cost. Requires a bachelor's degree of finance, business or healthcare administration. Additionally, Medical Policy Manager typically reports to head of a unit/department. The Medical Policy Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Policy Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
Accreditation and Policy Manager
Revision Date: 08/23/2021
Department: Tribal Council
Employment Status: Full Time
Program: Quality/Compliance/Privacy
FLSA Status: Exempt
Reports To: Assistant Director - Quality Assurance and Data Analytics
Schedule: 40 hours/52 weeks
Supervises: Accreditation and Policy Technician
Preference: TERO Ordinance 2017-01, P.L. 93-638
Job Summary
The Accreditation and Policy Manager is responsible for the monitoring and maintaining the Policy Management Program that will house all of the Kenaitze Indian Tribe's (the Tribes) policies, procedures, standard work, forms, Charters, Ordinances, and other documents. The Accreditation and Policy Manager ensures that all documents in the system are managed by responsible leaders in accordance with Federal, State, and accrediting bodies to maintain certification and licensure. Recommendations for documents will meet or exceed best practice principles, encouraging staff to provide quality and safe care for our patients/clients (un'ina). Consults with legal when needed. The Accreditation and Policy Manager will take a lead role in collaborating with department heads in Behavioral Health (BH) and Primary Care to maintain continual compliance with Commission on Accreditation of Rehab Facilities (CARF) standards. Investigation into other potential accreditations will be reviewed annually, with a summary of recommendations to be presented to the Tribal Council.
Essential Functions
It is the intent of this job description to highlight the essential functions of the position; however, it is not an all-inclusive list. The incumbent may be called upon and required to follow or perform other duties and tasks requested by his/her supervisor, consistent with the purpose of the position, department and/or the Kenaitze Indian Tribe's objectives.
Working Conditions
Lifting Requirements
Physical Requirements
OSHA Categories
Travel
Qualifications
Education
Experience
Preferred
License/Certification
Special Skills
This position is a Covered Position subject to all requirements of the Alaska Barrier Crimes Act (ABCA) and to the Indian Child Protection and Family Violence Prevention Act, (ICPA). ABCA and ICPA requirements apply and must be complied with at all times in order to remain in the position