Senior Manager Service Delivery

Gainwell Technologies LLC•Any city, OH

3d•$108,400 - $154,800•Hybrid

About The Position

This leadership role is responsible for the day-to-day operations of the Utilization Management (UM) contract and serves as the single point of contact and liaison for client, vendors/contractors and the Gainwell UM product management teams. Your role in our mission is to unleash the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Requirements

Bachelor's degree in business, health care, engineering, information systems or related field preferred
10+ years operations leadership/management experience, preferably in a healthcare or managed care environment
Minimum of 3-5 years Utilization Management operational and/or Account Management experience
Knowledge of Utilization Management operational processes (case triaging, call center, mailroom, etc.)
Understanding of MITA Business Processes, MMIS or Medicaid Enterprise System (MES) DDI, Operations and modularity, Medicaid programs, and CMS Certification Requirements are preferred

Responsibilities

Responsible for overall UM contract performance (primary contractor and subcontractor) and completion of tasks, quality and timing of deliverables, and compliance with contract requirements
Relationship with customer and stakeholders. Oversee all project resources, including Gainwell staff, vendor resources and ensure that appropriate resources are available and performing effectively throughout the contract lifecycle
Develop and maintain executive dashboards and metrics-driven reporting for leadership, highlighting UM program performance, regulatory compliance, and operational KPIs/SLAs
Coordinate with Executive Advisory, Medical Leadership, Clinical, Operations, Analytics, QA, Training, and Systems/IT teams to ensure services are performed in accordance with quality and efficiency standards while achieving appropriate contract results/outcomes
Liaise with Gainwell product management in developing the product roadmap to meet the customer requirements and ensure the product meets the customer’s quality/regulatory standards
Ensure compliance with Medicaid regulations, CMS guidelines, and state-specific requirements throughout the contract lifecycle
Provide leadership and direction to ensure implementation of service delivery strategies and metrics to continuously improve customer satisfaction. Coordinate delivery timelines and dependencies, proactively managing risks and prioritizing initiatives with stakeholders.
Ensure the data analysis of patterns and trends of utilization of Medicaid services (members, providers, claims, case outcomes, etc.) is conducted to evaluate efficiency of health care delivery, appropriate use of health services and opportunities to improve quality of care
Present roadmap, status reports, data analysis patterns etc. to the appropriate customer and internal stakeholders
Recruit, train and grow team members
Travel to the client’s location for meetings, training, and other contract matters as needed.