Assistant Manager-Inpatient Services

Job Title: Inpatient Services Assistant Manager

Department: Operations Fulfillment

Division: Operations Division

Reports to (Position of Immediate Superior): Manager, Inpatient Services

Supervises (Positions of Subordinates): Supervisor, Inpatient Services

Primary Job Responsibility

Responsible for planning, organizing, managing, and controlling their respective departments or units;

helps establish objectives and strategies to ensure Corporate and Departmental business plans and

Quality objectives are met; and Supervises both Processes and People:

• Process responsibilities include activities such as:
• Work Unit Planning and Implementation
• Task Assignment and Scheduling
• Problem-solving and Decision-making
• Monitoring and Evaluating Results
• Escalating issues and/or risks
• People responsibilities include activities such as:
• Developing Team and Individual Skills and Capabilities
• Mentoring, Coaching and Job-shadowing
• Engaging and Motivating employees
• Rating Performance Reviews
• Monitoring and providing feedback on day-to-day performance
  
  

I. Job Description

• Duties and Responsibilities done at PERIODIC or REGULAR Intervals
• Reviews the overall team performance in achieving required Key Result Areas and Key Performance Indicators. Monitors the functions and productivity of IP supervisors and respective team members in rendering service to clients in identified provider and area assignments
• Reviews, approves/disapproves within designated authority limits and overrides letter of authorization issued by Liaison Officers and supervisors to assigned providers during and after confinement
• Collates data from team members for purposes of documentation and review, audit, investigation, and analysis as may be required by the Immediate superior officer (i.e. incident reports, data info gathered from member/doctor/provider/internal)
• Validates, verifies, approves and disapproves daily time records, official or business trips, transportation and other necessary expenses and reimbursements of direct reports
• Collects, collates and analyzes medical documents such as but not limited to, medical certificate, operative record, diagnostic results, clinical abstract and Statement of Account (SOA) data for purposes of reviewing incurred hospital charges with the goal of managing and preventing Fraud, Waste and Abuse (FWA) based on medical criteria set by management and does escalation to Medical whenever necessary
• Handles and manages all types of escalations from designated team or unit prior to hand off and escalation to dependencies, as appropriate & applicable (i.e. Medical, PNM, UEF, Sales, Ops), enables collaboration and ensures action for case resolution and service recovery Ensures team compliance to required documentation of confinements such as but not limited to the usage of Salesforce, Genesys and other trackers
• Submits accurate, timely, and complete reports (i.e. weekly and monthly LOA actual versus target with analysis, metrics of team performance or any report as deemed necessary)
• Reviews and contributes in updating work processes, policies, procedures, work instructions, workflow, and other documentation as may be required in compliance to existing ISO Certification 9001:2015 standards
• Ensures manning flexibility in cases of absence and/or reassignments and provide resolution
• Duties and Responsibilities done at IRREGULAR or INTERMITTENT Intervals
• Conducts spot visits to hospitals and their staff to validate performance based on processes, policies and provided services, attitude to confined members, billing and payment concerns and other concerns
• Reviews, analyzes, resolves or escalates concerns and complaints raised by Supervisors and Staff regarding attitude of Supervisors or Liaison Officers, denial of cases, application of benefits and issuance of limits
• Acts as an internal auditor and documentation officer for the Inpatient Services Department
• Assists in conduction and development of training programs and evaluation of processes and employee performances
• STANDARD RESPONSIBILITY STATEMENTS
• Strives to embody, commits to support and deliver the quality policy, objectives and initiatives of the organization;
• Communicates, engages, directs and supports people to contribute to the QMS effectiveness;
• Demonstrates commitment to customers by ensuring applicable statutory and regulatory requirements are determined, understood and consistently met;
• Abides by the QMS policies and procedures for the effective management and control of its processes; and
• Promotes and utilizes Process Approach and Risk-based Thinking at work
• Performs other RELATED functions that may be assigned BY THE IMMEDIATE SUPERIOR
  
  

JOB SPECIFICATIONS

• EDUCATIONAL REQUIREMENT
  
  

MINIMUM educational level and background required by this POSITION: College Graduate of 4, 5 year-course, preferably:

Allied Medical Course

• EXPERIENCE AND TRAINING
  
  

PERIOD OF TIME OR LENGTH of related experience the CANDIDATE must acquire before being

assigned to and perform the functions of this job, SATISFACTORILY under NORMAL supervision:

Five years - Less than 10 years

• SKILLS REQUIREMENT EXECUTIVES AND MANAGERS
  
  

Broad: INTEGRATION and coordination of activities within a SINGLE management area