Medical Affairs Operations Manager
About The Position
The Medical Affairs Operations Manager is responsible for supporting the standardization, management of data, and workflow optimization for the Medical Affairs team. This role will function as a central hub to triage, prioritize, and manage operational workflow challenges, including data reporting standardization and technology implementation. Essential Functions: Partner with Medical Affairs leaders to enhance productivity and ensure alignment with company objectives. Oversee the long term tracking and trending of high priority items, including automated prior authorization processes, market reviews related to high utilization and/or cost, and process improvement/automation in appeals, clinical policy and quality of care. Manage and report on productivity and performance metrics, including MD and vendor auditing. Develop consistent and standardized reporting across all teams for regular updates to senior leadership. Investigate and analyze issues identified by leaders through data, focusing on state complaints and concerns. Support Key Performance Indicators (KPI) review for potential Quality and Affordability Initiative (QAI) projects. Track project timelines and develop a comprehensive tracker to manage, communicate, and organize all ongoing projects. Facilitate multidisciplinary and cross departmental collaboration for project management and QAI development. Focus on optimization initiatives, including AI applications, workflow enhancements, automated documentation, and standardized data reporting. Lead routine meetings to ensure alignment and progress on projects. Develop tools to improve efficiency and automate tasks to avoid manual data entry. Develop centralized educational sessions for front line MD, Appeal MD, and nursing teams. Gather information for vendor Requests for Proposals (RFPs). Represent Medical Affairs in the implementation and integration of new business initiatives. Perform any other job related duties as requested.
Requirements
- Bachelor's degree in healthcare administration, nursing, or a related field required
- Equivalent years of relevant work experience may be accepted in lieu of required education
- Five (5) years project management experience in a healthcare setting required
- Skilled in project management, data analysis, and operational workflow optimization
- Strong analytical skills with the ability to interpret complex data and identify trends
- Excellent communication and interpersonal skills
- Proficient in project management tools and data reporting software
- Ability to work independently and manage multiple projects simultaneously
- Current unrestricted license as and Registered Nurse (RN) or Nurse Practitioner (NP) required
- MCG certification is required or must be obtained within 6 months of hire required
Nice To Haves
- Master's degree preferred
- Project Management certification preferred
- Six Sigma or other certification in process improvement preferred
Responsibilities
- Partner with Medical Affairs leaders to enhance productivity and ensure alignment with company objectives.
- Oversee the long term tracking and trending of high priority items, including automated prior authorization processes, market reviews related to high utilization and/or cost, and process improvement/automation in appeals, clinical policy and quality of care.
- Manage and report on productivity and performance metrics, including MD and vendor auditing.
- Develop consistent and standardized reporting across all teams for regular updates to senior leadership.
- Investigate and analyze issues identified by leaders through data, focusing on state complaints and concerns.
- Support Key Performance Indicators (KPI) review for potential Quality and Affordability Initiative (QAI) projects.
- Track project timelines and develop a comprehensive tracker to manage, communicate, and organize all ongoing projects.
- Facilitate multidisciplinary and cross departmental collaboration for project management and QAI development.
- Focus on optimization initiatives, including AI applications, workflow enhancements, automated documentation, and standardized data reporting.
- Lead routine meetings to ensure alignment and progress on projects.
- Develop tools to improve efficiency and automate tasks to avoid manual data entry.
- Develop centralized educational sessions for front line MD, Appeal MD, and nursing teams.
- Gather information for vendor Requests for Proposals (RFPs).
- Represent Medical Affairs in the implementation and integration of new business initiatives.
- Perform any other job related duties as requested.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
11-50 employees
