Under the direction of the Regional DME/P&O/Continuum Claims Processign Centers Service Director, provides leadership and direction for the DME Department. Collaborates with other DME Managers and Supervisors to ensure consistency in the provision of services. Works with KFHP and medical group staff to ensure quality and cost effective services which are aligned with federal, state and local regulations.
Manages the start-up & day-to-day operations of the sub-regional appointment & advice call center (w/ 110- 315 employees) for multiple medical centers & CSAs. Enhances, refines, & implements a customer service level for the call center which includes partnering w/ TPMG providers & staff.
Essential Functions:
- Provides day-to-day management & supervision for the start-up & on-going operation of centralized sub-regional appointment & advice call center & ensures all services levels are met.
- Contributes to the high quality of service & member satisfaction through supervision of trained, competent & motivated staff.
- Analyzes daily, weekly, & monthly statistical reports & makes appropriate recommendations/forecasts regarding call volume & staff schedules.
- Provides accurate & pertinent data to Director for use in strategic planning & access goals.
- Partners w/ providers, resolving issues regarding same day booking/return appointments, provision of medical advice/triage.
- Resolves patient, provider, & staff complaints, issues, & concerns.
- Provides input into development of call center budget & ensures department remains within the budget.
- Assists in coordinating for opening new services for the call center & developing & maintaining policies/procedures.
- Manages staff development & work standards.
Secondary Functions:
- Manages overall operations of the NCAL Regional DME Department.
- Supervises the utilization management program for the DME Department in conjunction with the RN Clinical Supervisors to insure appropriate administration of the DME benefit.
- Develops and maintains a quality program for the DME Department to include collection and assimilation of data to enhance quality of services.
- Ensures compliance with administrative, legal, and regulatory requirements in the provision of DME services.
- Develops services that achiee a high level of customer satisfaction with emphasis on customer service, highest standards of quality and innovation.
- Investigates problems and questions, compiling data for regular review and making recommendations for performance improvement activities.
- In conjunction with Department Administrative Managers and RN Clinical Supervisors, assures efficient and effective operations for the department, quality services and utilization management.
- In conjunction with the DME Service Director directs the budget and resource allocations for the department. Partners with internal customers to support key initiatives where DME may play a role.
Qualifications:
Basic Qualifications:
- Minimum five (5) years of experience in health care, managing a large staff.
- Experience w/ an inbound call center preferred.
- Bachelor's degree required.
- Management of inbound customer service call centers/or centralized appointment /medical advice.
- Knowledge of queuing theories, work force scheduling, telecommunications, & trunking.
- Knowledge of appointment systems & procedures.
- Demonstrated leadership/motivation skills & experience w/ clerical & nursing staff.
- Ability to develop service strategies for servicing internal & external customers.
- Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
- RN Preferred.
- Masters Degree Preferred.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.