Review primary complex survey data sources and quality assurance processes (e.g. ongoing surveys conducted by CDC) including question wording, order, skip patterns, valid fields, Computer-assisted telephone interviewing (CATI), and etc. Become intimately familiar with the Computer-assisted telephone interviewing (CATI), survey/data source and corresponding documentation in order to server as a consult for analysis data set creation, quality assurance issues, and analytic issues:
Track all deliverables related to the data deliveries, quality assurance issues, programs files (i.e. SAS, Excel, Word, output, documentation, and etc.).
Check incoming data and corresponding documentation for accuracy and completeness. Requires detailed review of the data and CATI to uncover inconsistencies, should any be discovered.
Create and document analysis variables and data sets including rules for how missing values were handled and any caveats in the data.
Produce output that checks for accuracy of new variable and data set creation
Maintain all documentation of decisions that went into creating analysis variables, including decision dates (especially for variable definitions that change over time).
Follow consistent variable naming conventions and creation of variable labels and formats
Provide information for analysis reporting on how results were checked for accuracy (e.g., use of external data sources, published estimates, etc.)
Must have the ability to work with mid-sized teams and independently.
Serves as a writer, editor on assignments requiring research, development, and the creation of content for inclusion in a wide variety of materials including reports, publications, presentations, and web and social content.
Develops and disseminates information to internal and external audiences to keep them informed of the programs, accomplishments, and activities.
Works with key personnel in writing, editing, and proof-reading public information documents, progress reports, and related informational materials for external and internal audiences.
Writes, edits, proof-reads, and web site content
Assists with logistics and support for the planning and execution of various events
Engaging in early strategic consultation related to top DGHT priorities and sensitive issues with the Branch Chief, Office of the Director, and other colleagues to inform communication strategies and tactics.
Making expert recommendations to maximize the opportunities or mitigate the threats presented by these top issues.
Develop key messages in support of Division programs, initiative and issues
Develop and distribute division-wide routine communications (e.g. newsletters, Updates, blogs, fact sheets, briefing documents, intranet and external website content)
Review materials before they go to Office of the Director for clearance
Media relations to include media planning, materials development (e.g. press releases and media kits), media pitching and media training
Develop executive communications including leadership presentations and speeches
Integrate and monitor social media tactics into overall communications efforts
Develop outcomes based strategies and support media engagement and strategic outreach to key audience.
Identify trends and possible proactive pitches, create reactive statements as needed.
Monitor media coverage for the division work based on executed strategies
Provide senior level communications consultation to Division leadership and SMEs on audience’s tools, channels and evaluation
Gather and analyze relevant data for the development of communication products
Evaluate work flow and identify barriers, root causes and remedies affecting quality of submission to achieve a reduction in rework
Translate scientific information into easy-to-understand language for non-scientific audiences
Respond to inquiries or information requests from headquarters and the field and provide communications guidance
Other areas of support include:
Conduct environmental scanning and monitoring on highly-complex and sensitive issues as requested.
Identify key issues that are opportunities or threats to the division priorities and strategy
Provide strategic counsel to support partner engagement to maintain existing relationships and add need ones with external stakeholders
Support all message development including those for partner engagement
Support product development
Research content to support the division messaging
Edit materials and products as required
Monitor and evaluate the effectiveness of communications outreach and efforts
Duties for the Healthcare Claims Specialist include: • Resolving pended healthcare claims, prior approval requests and responding to providers. • Analyzing claims to determine whether or not the claims should be approved or denied for payment. • Reviewing and addressing provider inquiries regarding claim adjudication. • Applying knowledge of medical coding and various medical claims forms to the claims process.
Duties for the Healthcare Claims Team Lead include: • Resolving pended healthcare claims, prior approval requests and responding to providers • Analyzing claims to determine whether or not the claims should be approved or denied for payment • Reviewing and addressing provider inquiries regarding claim adjudication • Applying knowledge of medical coding and various medical claims forms to the claims process. • Managing daily workflow for a team of specialists including training of new specialists and ongoing operations • Handling escalated or complex claims • Generating reports and analysis using MS Excel • Developing and maintaining claims operations policies and procedures • Auditing the work of claims examiners
Establishes contract management systems to track activity, quality and progress against specified tasks.
Coordinates and tracks all deliverables requests.
Ensures project deliverables are on time and budget while meeting customer satisfaction expectations.
Ensures full-time and part-time staffing needs are met in a timely fashion.
Develops and implements a recruitment and retention strategy to meet staffing requirements, as well as supervises recruitment and hiring.
Oversees staff training and development to ensure professionalism and skill enhancement.
Oversees contract performance monitoring and documentation.
Mitigates project risks and manages issues related to staffing, budget, and systems to ensure quality control.
Accurately forecasts, reports, and manages project costs (budget). Effectively establishes and uses budget tracking approach and metrics that accurately track team productivity, earned value, and ROI.
Works closely with the HHS COR on project planning and setting timelines for meeting big picture program objectives.
Maintains effective communication with the HHS COR, with timely and accurate information on project changes as relates to staffing, systems, or budget.
Anticipates client needs and proposes appropriate solutions.
Responsible for formulating and enforcing work standards, assigning contractor schedules, supervising contractor personnel and communicating policies, purposes, and goals of the organization to subordinates.
Manages the overall business process and direction of the award.
The Senior Program Manager will be responsible for taking care of all the technical, administrative, and financial duties.
Provide management oversight of the case management team and operations to ensure efficiency and effectiveness of the case management program
Responsible for developing programs to improve Care Management and assist case managers and their support system to become engaged in a collaborative process designed to manage medical/social/mental health conditions for members more effectively
Design case management program to enhance consistency in services provided and reporting
Outlinee and definee the key components of a comprehensive care management program and provide examples of tools and strategies to effectively meet the needs of members with complex and special needs
Build a comprehensive care management plan and aligning the work force to the appropriate initiatives and measures
Work collaboratively with executive leadership, medical directors, operations, provider network, government products, project management and informatics to identify, develop, implement and monitor programs and processes
Report program effectiveness and metrics to the executive leadership
Proven ability to understand Care Management trends and to develop initiatives designed to bend trend while insuring appropriate access to quality care
Lead and motivate clinical and administrative staff to achieve specific objectives
Understand and analyze complex business problems and apply cost effective solutions
Review authorization activity and claim reports recommending placement in case management as indicated by comprehensive assessment
Respond to requests from Clinical Centers of Excellence providers to evaluate individuals for the case management program
Develop plan of care in conjunction with the patient's significant other, provider and payer
Implement plan of care for individuals in inpatient, home, rehabilitation, and/or skilled nursing settings
Transition patients to appropriate level of care coordinating services to meet care needs and obtaining vocational or psychosocial assessments as well as physical requirements to plan and implement plan of care
Educate the patient on condition, health care system
Function as patient advocate
Coordinate services to avoid duplication and provide integration of care plan components
Monitor ongoing care, satisfaction with care providers, and movement toward goals through interaction with patient, significant others, providers, and payer
Interact with the patient and/or designated significant other on a minimum of a monthly basis for evaluation, continued assessment and coordination of care
Create reports for client to indicate cost benefit of case management services
Maintain awareness of community resources and other resource availability for services outside or complementary to benefit structure. Integrates community resources to implementation of plan where possible
Actively involved in internal department procedures and internal quality management program (clinical and operational quality)
Review plan of services established for patient for effectiveness and appropriateness of care and satisfaction with services
Solicit feedback from providers and patients on satisfaction with case management services
Research clinical criteria as indicated
Evaluate outcomes as a result of utilizing health status surveys with members as well as through satisfaction questionnaires
Communicate with providers for establishing plan of care, obtain clinical updates and coordinate referrals and pre-authorizations when indicated
Collaborate with other departments and serves as a liaison to improve communication and customer service
Collaborate with other departments within the organization