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Spectrum Health Manager Medical Business Systems Priority Health in Grand Rapids, Michigan

CURRENT SPECTRUM HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Spectrum Health team members only.

Job Description

Job SummaryProvide leadership and direction to assigned team analysts to assure that goals and standards of all areas are being met. Provides project management leadership on strategic initiatives impacting core business systems. Provides subject matter expertise on key features and functionality of core business system. Serves as vendor manager, business application support manager for all products including GuidingCare, EviCore, Change Health working across business operations, IS and business segments to lead the future of the platform. Facilitate the development of assigned teams and development of cross functional work teams. Participate in ongoing implementation and support of new products and technologies.All employees in all positions must:Adhere to Spectrum Health’s mission, vision, values, key strategies and policies.Ensure that services are provided in accordance with state and federal regulations, accreditation and compliancerequirements, and organizational policy.Maintain reliable attendance and follow all call-in rules for the safety and welfare of our patients.Interact with co-workers, staff of other affiliates, patients, members and visitors in a positive and professional manner andcommunicate effectively and respectfully.Work as a team member helping others to contribute to the overall success of Spectrum Health.Satisfaction of these core expectations is considered an essential function of all positions at Spectrum Health.Essential Functions

  • Management Responsibilities (Strategic): Contributes to the overall management strategies of the department. Responds to the needs of the department and its team members. Collaborates with other managers, supervisors and team members to solve technical and personnel issues. Clarifies direction provided by senior management. Recommends policy changes to improve department. Works closely with other supervisors and managers to assure proper alignment with long term team, department and corporate goals. Responsible for the technical and interpersonal performance of individual team members.Provides input into the development of departmental budgets. Manages costs to approved budget. Serves as vendor manager and product operations manager of all Medical Management products working across operations, IS, and business segments to lead the stability and availability of the platformManagement Responsibilities (Day to Day):Effectively leads the day-to-day running of products (GuidingCare, Interqual, Evicore) including turnaround times and quality standards. Effectively and actively works within the Business Teams to allow for the free flow of ideas in an open atmosphere. Represents team in meetings and projects as requested by management. Monitors audit reports and spreadsheets to ensures that we are compliant with CMS, NCQAA and other compliance requirements. Develops, implement and maintain performance tracking and trending tools to allow for daily monitoring of team's performance level for all functions.ESSENTIAL FUNCTIONS - ROLES AND RESPONSIBILITIES (For this Position)Assists and/or performs hiring, evaluations and terminations of employee(s) supervised in accordance with Priority Health policy.Identifies training needs within teams and develops appropriate action plans.Project Management: Provides project, vendor and program management expertise and support to capital and strategic initiatives, promotes and develops these capabilities within members of assigned teams. Participates to ensure successful delivery of a wide range of small/medium large and enterprise wide projects and programs. Participate in the Process Improvement Planning (PIP). Participate in PMO resourcing and planning meetings. Effectively develop, prioritize and implement project plans as assigned by management. Communicate project goals in a clear and timely manner. Give input and sets priorities on a small, medium and large scale. Identify, secure and coordinate department resources.

Qualifications

  • Required Bachelor's Degree or equivalent Health Care related field

  • 5 years of relevant experience Leading teams in use/configuration/maintenance/testing of FACETS software (or comparable healthcare payer business system) Required

  • Experience with FACETS Software preferably in one or more of the following areas: Pricing configuration/maintenance, Provider configuration/maintenance, Product configuration/maintenance, Group Administration configuration/maintenance, Enrollment maintenance, Claims Required

  • Healthcare payer business system vendor management experience managing the interactions, monitoring performance of core business system application vendor in a healthcare payer setting Required

  • 5 years of relevant experienceLeading teams in use/configuration/maintenance/testing of Care Management products (or comparable healthcare payer business system)

  • Experience with Care Management Software preferably in one or more of the following areas: Pricing Preferred

Primary Location

SITE - Priority Health - 1231 E Beltline - Grand Rapids

Department Name

PH - Medical Business Operations

Employment Type

Full time

Shift

Weekly Scheduled Hours

40

Hours of Work

8 a.m. to 5 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

Accommodation Notice: If you are a qualified individual with a disability, you may request a reasonable accommodation in Spectrum Health's application process. Contact us at 616-486-SHHR (7447).

Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected

category. See more here (https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf) .

Who We Are

Spectrum Health is a nationally recognized not-for-profit health system, offering a full continuum of health services through our health plan, medical group and hospital group. As an integrated health system, we are able to work together across all facilities, employees and providers to create exceptional, consumer-focused interactions.

Spectrum Health is redefining what it takes to improve the health of our communities and introducing new and innovative ways for consumers to access high-quality, low-cost care so that they can connect with us for a lifetime of health.

We strive to provide one Spectrum Health experience: a consistent, high-quality, seamless health journey for consumers; no matter where, when or how they interact with us. The result is better health outcomes for the thousands of individuals, families and communities we serve.

We are the region’s largest employer, with corporate offices located in Grand Rapids, Michigan. Spectrum Health Hospital Group and Spectrum Health Medical Group are consistently recognized for the exceptional care they provide. Priority Health is among the largest health system-sponsored health plans in the U.S. and offers extensive experience serving large and small employer groups, individuals, Medicare Advantage, Healthy Michigan Plan and Medicaid populations.

Since 2010, Spectrum Health has been listed five times among the 15 Top Health Systems in the U.S. by Truven Analytics™. Click here (https://www.spectrumhealth.org/about-us/quality-safety-and-patient-experience/awards) to see a complete list of our safety, quality and patient experience awards.

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