Manager Adjudication DME

Responsibilities Remote Opportunity: Manage teams and staff assigned. Develop, monitor, and use quality control procedures and audit criteria to ensure consistent application of contractual requirements and established policies and procedures. o Oversee the adjudication activities of the DME QIC including case triage, clinical adjudication, technical adjudication, decision letter development, and certain components of the DME demonstration related to adjudication and telephone discussions o Manage teams ensuring they follow MAXIMUS policies and procedures o Manage workload volumes to ensure timely completion of all appeals o Develop and implement operational policies and procedures with key stakeholders o Work directly with the project director on adjudication issues relative to DME and the DME demonstration o Administer performance management processes to include developing and implementing training plans, monitoring quality and productivity, administering corrective/disciplinary action when necessary, and administering the performance evaluation process o Assist teams when necessary in coordination of case processing and workload adjustment o Act as liaison for the management team with other shared services functions, including Production Services, Training, Performance Management, and Business Intelligence as necessary o Consult with Physician Reviewers and Medical Directors, as necessary o Develop, monitor, and use quality control procedures and audit criteria to ensure consistent application of contractual requirements and established policies and procedures o Maintains updated knowledge of Client requirements o Manage recruitment and hiring of staff o Perform other duties as may be assigned by management o Act as a point of contact with the Centers for Medicare & Medicaid Services, as needed o Coordinate and communicate with provider associations and other outside entities, Bachelor's degree from an accredited college or university required, preferred field of study in Health Services o Clinical degree (e.g. RN, RPh, etc.) and/or an advanced degree (Masters, Doctorate, JD) preferred o Five years' work in team-based operations o Experience with DME preferred o Medicare experience required o Minimum of five years management experience; o Experience working with Quality Assurance o Demonstration of year-over-year improved efficiency and innovation o Evidence of analytic problem-solving skills o Excellent organizational, interpersonal, written, and verbal communication skills o Ability to perform comfortably in a fast-paced, deadline-oriented production environment o Ability to adapt to and be an agent of positive change in a developing work environment o Ability to successfully execute many complex tasks simultaneously o Ability to work as a team member, as well as independently o Proficiency in software application including but not limited to MS Office The Ideal Candidate will Possess the Following Additional Education and Experience Manages, perhaps through subordinate supervisors, the coordination of the activities of a section or department with responsibility for results, including costs, methods and staffing. In some instances this manager may be responsible for a functional area and not have any subordinate employees. Works on issues of diverse scope where analysis of situation or data requires evaluation of a variety of factors, including an understanding of current business trends. Follows processes and operational policies in selecting methods and techniques for obtaining solutions. Acts as advisor to subordinate(s) to meet schedules and/or resolve problems. Develops and administers schedules, performance requirements; may have budgetresponsibilities. Frequently interacts with subordinate employees, customers, and/or functional peer group managers, normally involving matters between functional areas, other company divisions or units, or customers and the company. Often must lead a cooperative effort among members of a project team. Receives assignments in the form of objectives and determines how to use resources to meet schedules and goals. Provides guidance to subordinates within the latitude of established company policies. Recommends changes to policies and establishes procedures that affect immediate organization(s). 2018-35491
Salary Range: NA
Minimum Qualification
5 - 7 years

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