Care Management Business Operations Manager

As Mount Sinai grows, so does our legacy in high-quality health care.

Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers.

Culture of Caring: The Sinai Way

Our hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence.

Position Responsibilities:

Develops and maintains effective relationships with payors, including contact as required with representatives from payors to ensure accomplishment of utilization management activities included pre-certification and re-certification. Oversees the management of observation cases, both concurrently and retrospectively, as needed.Supports the clinical denial management process, ensuring information related to denials and the appeal process is coordinated with the Denial Specialist, Patient Financial Services, Patient Access, and the appropriate Care Manager.Ensures concurrent flow of information between the Case Management Department and other MSMC departments responsible for managed care contracts and patient accounts/billing.Participates with other MSMC entities who are involved in the denial management process to ensure that denials and appeals are tracked, trended, and reported to Care Management staff for appropriate intervention as needed.Communicates with patients and families as necessary when issues about insurance coverage arise.Generates and interprets reports/conducts audits to ensure compliance with documentation; follows up on any areas/individuals identified as having room for improvement.Addresses any compliance issues identified by regulatory agencies, including submitting clarification or tracking performance as part of an action plan.Collaborates with other departments to generate outcome data as needed to measure and trend performance indicators identified in the Utilization /Medical Management Plan.Develops and updates departmental data reports on a regular basis (monthly or weekly, as appropriate) or oversees the generation of these reports.Participates in hiring, reviews, discipline, and grievance handling to ensure optimal individual and team performance.Participates in staff development activities, interacting as needed with the director, customers, and others to continuously improve competency and effectiveness of the department.Identifies and addresses skills or behaviors requiring improvement, both at an individual level and at a department level.Provides coaching as needed to optimize performance and ensure safe and satisfactory care to patients and optimal customer service.Supports Director in development of department operational budget. Analyzes costs, identifies/develops strategies to ensure compliance with budgetary constraints and provides justifications for budget variances.Communicates with IT regarding Care Management Department software needsAddresses service problems with outside companies, including home health agencies, nursing homes, transportation, and others as they arise.Provides daily oversight and management to the administrative and resource center staff; assists the team lead in managing the payor support staff. Ensures that all of the functions of the support staff are accomplished.Engages in self-development in clinical, professional, and managerial areas; successfully completes leadership development curriculum.Adheres to standards, policies and procedures at both the hospital and Departmental level.Promotes a service orientation in the performance of position duties and responsibilities and in interactions with patients, hospital staff and visitors.

Qualifications:

Bachelor's Degree5 years management experience required.

Benefits:

We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs. Our robust employee benefits package includes:

Health benefitsLife insuranceLong-term disability coverageHealthcare spending accountsRetirement planPaid time offPet InsuranceTuition reimbursementEmployee assistance programWellness programOn-site housing for selected positions and more! Share