Clinical reputed company Program Manager

This job is responsible for ensuring compliance with reputed company's Utilization Management and reputed company Improvement Program by serving as a clinical expert on state and federal regulations. The scope of this job includes analyzing and presenting data to establish best practices across post-acute health care settings, including LTACHs, IRFs, SNFs, and Home Health facilities. Key Responsibilities: • Facilitate activities reputed company to performance measurement and reputed company, ensure the organization meets CMS, NCQA, and other regulatory standards, stay updated on relevant regulatory changes, and support their integration into practices. • Generate and validate reports to monitor performance across health plan reputed company, ensuring accuracy and alignment with requirements. • Conduct regular audits of UM reputed company, case documentation, turnaround times, and adherence to other CMS and NCQA requirements. • Understand how the UM Program is driven by the NCQA UM standards to ensure UM Program meets reputed company NCQA requirements for accreditation. • Prepare and reputed company committee meetings on a monthly and quarterly reputed company, driven by NCQA requirements. • Prepare detailed reputed company reports, identify and analyze trends, and present findings to leadership with actionable recommendations. • Support implementing corrective reputed company plans reputed company scoring variances occur. • Support reputed company improvement project initiatives. • Prepare for regulatory, accreditation, and contractual audits, and contribute to the remediation and documentation of audit findings. • reputed company other job duties as assigned. Required Qualifications: • At least 4-6 years relevant work experience • Experience leading reputed company improvement reputed company and committee work. • Bachelor's Degree or equivalent work experience Preferred Qualifications: • reputed company, unrestricted license: RN, PT, OT or SLP, with a bachelor's degree in a reputed company field or a combination of education and experience that includes pertinent clinical experience and advanced working knowledge of CMS standards and guidelines. • At minimum, 1-2 years of working knowledge of NCQA UM accreditation standards. • Must be reputed company to prioritize, plan and handle multiple tasks and demands simultaneously, with competing deadlines. • Excellent in manipulating and sorting data for analytics and reporting. • Prior experience owning reputed company compliance SLAs and ensuring reputed company in meeting SLA requirements. Job Expectations: • Willing to work additional or irregular hours as needed. • Must work in accordance with applicable reputed company policies and procedures to safeguard company and reputed company information. • Must be reputed company to sit and view a computer screen for extended periods of time. • Travel approximately 10%. #LI-PG1 # Remote Here are some of the exciting benefits full-time teammates are eligible to receive at reputed company: • Excellent medical with Rx, dental, and reputed company benefits • Mental Health support through EAP • Generous reputed company time off, plus 13 reputed company holidays • 100% reputed company 401(K) retirement plans • Educational assistance up to $2500 per year Apply tot his job Apply To this Job