Assistant Director of Program Operations

Summary:  

The Asst. Director of Program Operations is a key team member providing comprehensive oversight of programs to include organizing, coordinating, and monitoring all non-clinical operations of the Enhanced Service Teams This position is responsible for providing administrative support to the clinical and medical staff and ensuring the client experience is exceptional. Leads in accordance with Southeastern Integrated Care, Inc’s Purpose, Vision, and Mission while adhering to applicable NC 10A NCAC 27G and Clinical Coverage Guidelines 8A, C, D and G. 

Essential Duties and Responsibilities: 

• Supports the service line functions of the program to include intakes, utilization reviews, authorizations/verification of insurance, referrals, and team schedules.
• Assists in the maintenance and/or modification of client data collection in the agency EHR system to ensure information remains as up to date as possible. This includes but is not limited to patient demographics (phone number, emergency contact, mailing address, employment information, etc.)
• Serve as authorization specialist, reviewing all initial and renewing authorizations to MCO/Payor for submission and submitting timely to ensure proper initiation of care and no service gaps.
• Complete Intakes on new or renewing clients assigned to teams as needed.
• Manage processes related to new referral assignments and ensure timely initiation of care.
• Designs, organizes, establishes, and evaluates work processes to ensure delivery of program services and to fulfill program objectives. Studies existing policies, procedures, and directives and recommends revisions or additions when necessary.
• Facilitating weekly admin meetings with Team Leads, Director of Program Operations, and other team members.
• Oversee compliance with all technical aspects of team cases and collaborate with TLs, other team members, Director of Program Operations, and VP of Clinical operations to ensure no interruption with service delivery and associated billing.
• Assist with completion of required documents to ensure compliance with service definition requirements.
• Track team performance and beneficiary outcome data, and report to management as indicated.
• Providing support to the team by receiving calls and responding to office walk-ins, triaging, and coordinating communication and engagement between the team, individuals, referral sources, MCOs/payors, etc.
• Collaborating with internal team members re: billing and authorization needs.
• Assisting with training needs of team members as directed by supervisor or QM and Compliance Director.
• Assist in registering new patients and assisting patients with access to their patient portal.
• Assists in the maintenance and/or modification of client data collection in the agency EHR system to ensure information remains as up to date as possible. This includes but is not limited to patient demographics (phone number, emergency contact, mailing address, employment information, etc.)
• Interprets/explains Continuum Cares Services policies, processes, applicable laws, rules, regulations, and guidelines specific to a program to resolve problems, functions as an information clearinghouse for program questions, and provides information and advice to current and potential program participants on program issues and requirements.
• Coordinates action where several organizational entities are involved and follows up to ensure that all details and requirements are met.
• Reviews program operations for compliance, identifies program strengths and weaknesses and problem areas of non-compliance, recommends corrective action, and instructs individuals and groups on proper methods and procedures for compliance with program regulations.
• Assists with planning, monitoring, and evaluating the program area.
• Conducts orientation, training demonstrations, and presentations for individuals, groups, and organizations.
• Assists in the implementation and follow-up on executive decisions and requests as directed by Director of Program Operations. 
• Handles information of a highly confidential and critical nature on a regular basis, including the orchestration of reports and data regarding company programs and initiatives.
• Takes initial steps to facilitate the resolution of urgent/complex issues and notifies the supervisor. 
• Foster positive relationships while interacting with staff and various levels of management from within and outside of the agency to provide or gather information often of a sensitive and timely nature. 
• Build strong relationships with stakeholders and the community to ensure efficient and effective collaboration fostering an atmosphere of engagement, to ensure a high performance, client service-oriented work environment. 
• Interpret company policies, procedures, laws, and regulations in response to inquiries and complaints; refer inquiries as appropriate.
• Actively communicate with other departments within the agency the needs of the department. 
• Communicate with external agencies and personnel as needed.
• Coordinates training and on-the-job shadowing activities for new hires.
• Serve on agency committees and assist with training and development, auditing, and quality improvement activities as needed.
• Trains new volunteers and assistants as assigned
• Assists with the medication management process as needed.
• Assist with coordination of medical student and residency schedules with providers
• Conducts customer/participant surveys to gather information on program services and customer satisfaction, monitors program participants to ensure quality services are rendered, and provides continuous support to program participants to identify gaps in services.
• By position, resolves problems encountered during daily operations and determines appropriate solutions. 
• By position, contributes to the development of the performance enhancement plan, documents performance, provides performance feedback, and furnishes information for the formal performance evaluation.
• By position, responds orally to informal grievances and relays information to the supervisor.
• By position, documents situations which may be cause for disciplinary action and provides this information to the supervisor
• Conducts customer/participant surveys to gather information on program services and customer satisfaction, monitors program participants to ensure quality services are rendered, and provides continuous support to program participants to identify gaps in services.
• By position, develops or modifies work plans, methods, and procedures and determines work priorities and develops work schedules to provide adequate staff coverage. Provides work instruction and assists employees with difficult and/or unusual assignments. Assigns and distributes work, reviews work for accuracy and completeness, and returns assignments with recommendations for proper completion.
• Other duties as assigned.

Supervisory Responsibilities:

This position will provide supervisory support to Team Leads.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Training Requirements:

Associate Degree in Public Administration, Management, Sociology, Psychology, Political Science, or a related field with at least 8 years of management experience or bachelor’s degree in public administration, Management, Sociology, Psychology, Political Science, or a related field with at least 5 years’ experience of management experience or master’s degree in public administration, Management, Sociology, Psychology, Political Science, or a related field with at least 3 years of management experience.

NCI trained within 90 days

CPR/First Aid trained within 90 days

EMR competent within 90 days

Education/Experience Equivalency:

A combination of appropriate education and experience may be substituted for the minimum education and experience requirements.

Certificates, Licenses, Registrations

• N/A

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The work is typically performed in an office environment, with a moderate noise level. 

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Movements including but not limited to prolonged periods of sitting at a desk and working on a computer, occasional standing, walking, bending, and reaching are required. 
• Regularly required to use hands to handle or feel; talk; see; and/or hear. Specific vision abilities required by this job include close vision and color vision.
• Must be able to lift up to 15 pounds at all times.