Medical administrator job description

**This position is a full time remote, work from home opportunity. You must reside within the state of Florida.

POSITION SUMMARY: To be fully engaged in providing No Harm / Quality, Customer Experience, and Stewardship by applying broad medical, regulatory, and benefits administration knowledge to research, write, edit and implement Medical Policies. The position creates value by maximizing operational effectiveness in the Utilization Management, Claims and Appeals processes, ensuring consistent and appropriate decision-making and minimizing legal risk. The Medical Policy Administrator focuses on clinical decision analysis, cost-effectiveness and health policy analysis to develop and maintain a Medical Policy library for the Health Plan. Medical Policies will be developed by applying decision analysis, literature synthesis, medical informatics, and expert benefit interpretation. Medical Policies will combine information extracted from technology assessments, clinical guidelines, health outcome analyses, expert panels and conferences, as well as from pertinent clinical informatics and clinical decision support documentation. Additional responsibilities include maintenance of the Prior Authorization List with applicable health care coding references, and active participation in a variety of operational workgroups. Generally works under specific deadlines and frequently handles multiple complex projects, operating with minimal supervision. PRIMARY ACCOUNTABILITIES: . Quality/No Harm: Adhere to and enforce all corporate safety initiatives Ensures all Medical Policy content meets patient safety guidelines Provides professional and analytical support focusing on the analysis, development, maintenance, and evaluation of HFHP Medical Policies for all product lines Writes, proofs and edits Medical Policies including maintaining a detailed history of research, coverage determinations and recommendations. Makes high level presentations on research and recommendations to internal teams, and to the Physician Advisory Committee. Researches and identifies best practices and evidence based research studies in support of the development and maintenance of state of the art Medical Policies Prepares templates for Medical Policy documents and determines format for best presentation of data Ensures document content adheres to appropriate accreditation standards and regulatory guidelines Provides professional/analytical support with policy interpretation to applicable product lines, including implementation, operation and contract compliance (e.g. Medicare program) Oversees the development and maintenance of all departmental Policies and Procedures related to Medical Policy administration Consults with applicable industry resources, regulatory authorities and health plan administrators to facilitate the development and maintenance of applicable Medical Policies Ensures professional product is comprehensive and accurately reflects local medical practice Monitors and reports on industry developments which may impact applicable medical services offerings including legislative/legal developments at the local, state and federal level Maintaining and regularly updating the Prior Authorization List based on input from the Utilization Management Workgroup and clinical leadership Interacts with internal teams as needed to ensure that medical policies accurately address current workflow processes and operations Interacts extensively with medical directors and health plan clinicians regarding Medical Policies Utilizes health plan resources in determining accurate diagnosis and procedure coding for appropriate policy development Leads the Code Management Team in its review of new and existing procedure and diagnosis codes providing recommendations regarding coding that affects benefits, payment, and other operational processes. For the duration of the ICD-10 implementation project, acts as HFHP's business lead, conducting necessary financial and operational impact assessments, developing a project schedule and associated tasks, and developing and executing operational and communication strategies. Implements regulatory requirements related to preventive benefits, including extensive knowledge of related state and federal laws and specific guidelines, as well as overseeing code-level implementation of preventive services. Customer Experience: Develops and maintains effective systems to communicate information related to Medical Policies to internal and external customers Stewardship: Develops Medical Policies that support utilization management and appeal activities that are designed to ensure appropriate use of medical services

QUALIFICATIONS REQUIRED: Bachelor's degree or equivalent training in health or Business Administration is required. A degree in nursing is preferred. Masters degree a plus. Professional writing and editing experience required. Document/template formatting skills required as well. 8 years of health care/medical industry experience required at a professional/management level. Thorough knowledge of relationships between medical policy, member benefits, provider contracts, and claims operations. In-depth knowledge of diagnosis and procedure codes, reimbursement methodologies, medical terminology, and HFHP and CMS guidelines. Professional coding certification preferred. Strong command of the English language, including basic grammar and writing principles, and knowledge of medical terminology. Strong decision-making ability, interpersonal skills and communication skills. Professional coding certification preferred PHYSICAL DEMANDS: Ability to use a computer for extended periods of time, including sitting, typing, and viewing text on a computer monitor MENTAL DEMANDS: Maintaining a high level of motivation, initiative and accountability Staying organized and effectively prioritizing work and managing time Handling multiple tasks, often within limited time frames Working in a fast-paced and often stressful environment. Handling conflict in a productive manner Working effectively with all levels of employees and management COMPETENCY ASSESSMENT/SKILLS CHECKLIST: Advanced verbal and written communication skills, with proven ability to communicate professionally Motivation, initiative and accountability Data collection and quantitative decision-making skills Analytic and creative problem-solving skills Must be highly proficient in the use of Microsoft Office suite (especially Microsoft Word, Excel and PowerPoint) Organization and time management, with the ability manage multiple responsibilities effectively
**Job:** **Medical Management*

**Organization:** **HF Administrative Plan Inc*

**Title:** *Medical Policy Administrator -Remote in FL Only, Health First Health Plan, Medical Management, Full Time*

**Location:** *Florida - Brevard County*

We are looking to hire a U.S. Medical Leave Administrator in Rochester, NY as part of our WW Health, Safety and Environment Team.

Kodak offers a unique opportunity to contribute to the revitalization of an iconic global company. We combine the strength of a brand that is recognized and beloved around the world with the excitement and entrepreneurial spirit of a start-up. We are optimistic about the future and looking for professionals with energy, ideas, and ambition to help us take the next steps in completing our transformation. We're building a culture that values creativity in all its forms, having a global perspective, a focus on sustainability, and the kind of trust that enables us to succeed by taking calculated risks. Kodak has a rich heritage of leadership and innovation, but is also, in many ways, still inventing itself. At this stage of our comeback, Kodak is truly a place where you can make a difference.

As the U.S. Medical Leave Administrator, you will provide support to the Manager of U.S. Medical Services and Workers' Compensation and the Health, Safety and Environment Team.
Responsibilities may include (but are not limited to) the following:

* Work with contracted nurse case managers to identify employees out on medical leaves which include but are not limited to Disability, Family Medical Leave Act, Paid Family Leave, and COVID-19 sick leaves.
* Obtain the documentation necessary to justify medical leave benefits in accordance with state and federal regulations as well as Kodak policy.
* Provide pay coding instructions for applicable medical leaves to the appropriate personnel.
* Review absence reports to reconcile pay coding and identify errors.
* Administration of leaves requested under the provisions of the Family Medical Leave Act, state-mandated Paid Family Leaves, COVID-19 sick leaves, and Kodak's short-term disability program to include but not limited to eligibility determination, review of documentation to determine applicability of leave, issuance of forms in accordance with U.S. Department of Labor and state regulations as well as Kodak policy, providing absence and pay coding information to supervisors and Human Resources, and tracking of approved and unapproved leaves.
* Maintenance of all documentation and information in strict adherence to HIPAA privacy regulations.
* Preparation and/or review of applicable absence reports to verify the accuracy of information contained therein.
* Required communication with parties to include, but not limited to Human Resources, supervisors, state and federal regulatory agencies, medical offices, employees, and contracted medical services personnel.
* Assist the Manager of U.S. Medical Services and Workers' Compensation with other tasks not specifically identified but related to administration of employee-related medical leaves.
* Attendance at relevant medical leave workshops, webinars, and legal briefings to remain current with state and federal regulations.
* Participation in meetings related to employees requesting medical leave or Kodak's medical leave program.

Requirements:

* Relevant experience administering state and federal medical leaves
* Knowledge of U.S. Department of Labor Family Medical Leave Act regulations and New York State Paid Family Leave laws
* Ability to effectively communicate and maintain professionalism and tact in a variety of situations
* Able to produce high-quality work with attention to detail
* Ability to multi-task and complete responsibilities in a timely manner
* Ability to analyze problems and identify potential solutions
* Ability to perform role while consistently displaying Kodak's Values
* Proficient with Microsoft Office programs including Excel and Outlook

Education and Experience:

* A minimum of 3-5 years of experience in administering medical leaves including FMLA and state Paid Family Leaves
* Bachelor's degree in a related field preferred

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more - in our careers and in our communities.

The Medication Sourcing Administrator develops, deploys, maintains, and refines medication sourcing strategies for OhioHealth's Pharmacy operations on a system wide basis. This role is responsible for determining appropriate stock levels, balancing inventory turns with unpredictable and persistent medication supply channel disruptions to meet dynamic patient needs within the highly complex pharmaceutical industry while serving as gatekeeper for the organization's medication spend, in excess of $70M. This position will engage/influence key internal and external stakeholders to achieve optimal clinical and financial outcomes. The Medication Sourcing Administrator will develop demand planning analyses and forecasting models to seamlessly deplete stock ahead of formulary driven product conversions and/or medication shortage driven utilization shifts. This role is also responsible for evaluating
processes/workflows/databases
to establish/execute strategies for mitigating organizational risk associated with state/federal regulatory requirements (including SBOP, DEA, FDA, DSCSA, 340B, USP 797/800), TJC accreditation standards, safety
considerations/recalls,
contract compliance requirements and product pedigree/chain of custody/fiscal integrity considerations. They will serve a key role in the establishment of a system wide medication sourcing strategy requiring the coordination of key decision input factors from multiple, disparate pharmacy information systems.

Minimum Qualifications:

Bachelor's Degree
Degree in Business Administration, Healthcare/Finance/Supply Chain related field or 3 - 5 years Experience in business administration, healthcare, finance or supply chain role. Strong data analysis and analytical skills. Project management related skills. Excellent computer skills, Microsoft Suite of products, financial and inventory management systems. Knowledge of inventory management theory and practices; Process improvement methodologies. Proven professional customer service and training skills. Expert in sourcing clinical and non-clinical services and supplies. Excellent communication and problem resolution skills. Experience with or knowledge of accounts payable, contracting, inventory, data integrity and receiving processes. Pharmacy/Healthcare Supply Chain Services knowledge with a good understanding of the procurement cycle, pharmacy operations, healthcare services, supplies terminology and a broad understanding of a multi-hospital system or IDN. 5 -7 Years of Experience with increasing responsibility focusing on pharmacy operations and inventory analysis. Prior inventory management Experience .

Work Shift:
Day

Scheduled Weekly Hours :
40

Department
Corporate Pharmacy Services

Join us!... if your passion is to work in a caring environment... if you believe that learning is a life-long process... if you strive for excellence and want to be among the best in the healthcare industry

Equal Employment Opportunity

OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment