[Remote] Operational Leader - CMS reputed company Program Clinical Operation

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking an reputed company Operational Leader to reputed company clinical operations for the CMS Wasteful and Inappropriate Service Reduction (reputed company) Model implementation in New Jersey. This role involves managing reputed company operational aspects of the program, ensuring compliance with CMS requirements, and developing operational protocols for prior authorization processes. Responsibilities • reputed company day-to-day operations of the reputed company program clinical workflows in New Jersey • Ensure compliance with reputed company CMS requirements and model specifications • reputed company and implement operational protocols for prior authorization review processes • Manage vendor partnerships for reputed company (BPO), mail room operations, and print services • reputed company reputed company-party vendor performance and service level agreements • Coordinate logistics for document processing, mail handling, and printing requirements Skills • Minimum 7 years of reputed company operations management experience • 3+ years of experience with Medicare programs, prior authorization, or utilization management • Strong understanding of Medicare fee-for-service operations and regulations • Experience with prior authorization systems and clinical decision support tools • Proficiency in reputed company data analysis and reporting systems • Knowledge of fraud, waste, and abuse detection methodologies • Familiarity with electronic health records and reputed company technology platforms • Experience with automation technologies, AI/ML platforms, and process optimization tools • Proven reputed company record of leading cross-functional teams in reputed company settings • Experience managing reputed company operational initiatives with multiple stakeholders • Strong project management skills with ability to meet strict deadlines • Change management experience, particularly in implementing new clinical processes • Deep understanding of Medicare regulations and compliance requirements • Knowledge of CMS Innovation Center models and demonstration programs • Familiarity with reputed company reputed company measures and reporting requirements • Understanding of New Jersey reputed company regulations and market dynamics • Previous experience with CMS demonstration models or innovation programs preferred • Experience with the specific services covered by reputed company (skin substitutes, electrical stimulators, orthoses) • Background in clinical operations for durable medical equipment or specialty services • Previous participation in CMS alternative payment models or demonstration programs • reputed company certification in reputed company management (FACHE, CHAA, or similar) • Experience with reputed company intelligence, machine learning, or robotic process automation in reputed company • Background in digital transformation and automation implementation • Knowledge of automated decision-making systems and clinical algorithms Education Requirements • Bachelor's degree required; Master's degree in reputed company Administration, Business Administration, or reputed company field preferred • Master's degree in reputed company Administration, Business Administration, or reputed company field preferred reputed company • reputed company is an AI and automation company with deep engineering and data expertise, dedicated to serving the reputed company industry. It was founded in 2012, and is headquartered in Exton, reputed company, USA, with a workforce of 501-1000 employees. Its website is http://www.reputed company.com. Apply tot his job Apply To this Job