Job Responsibilities
My current responsibilities include oversight of:
- physician credentialing - couple of hours a week
- member appeals - 1 hour per week
- member complaints - 2 hours per week
- disease management - several hours per week
- preventive health - several hours per week
- HEDIS - depends on time of year - can be several hours per
week
- Regulatory oversight - if getting ready for NCQA can be up
to 40 hours per week.
- wellness - couple of hours per week
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Job Requirements
Masters program had an emphasis on quality improvement and
leadership. Was done at a New York State university taking
mostly evening classes while working full time. Workload was
reasonable with working. Exception was getting thesis completed.
Classes and professors were great with a lot of interaction with
learning from fellow class mates work experiences.
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Uppers
Best part of job is that it is never routine. There is always something going
on. Also, healthcare is a fast changing so you have to keep up with what is going
on.
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Downers
Regulatory requirements are difficult to keep up with. Before
you can change any processes you need to check the State, CMS
and NCQA standards to make sure you will still meet all
requirements.
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Lifestyle
Work hours are long. Evening meetings and a lot of travel. The dress code is
business casual except for outside meetings. There is only 1 social event outside
of work a year, which is around Christmas.
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Compensation
Base pay is $120,000. Annual bonus varies according to meeting
company goals. Can be up to $60,000 for my position. We can
purchase stock at a reduced price but my position does not get
stocks as part of salary package. Benefits include 4 weeks
vacation, 2 personal days, 7 sick days, dental, vision and
healthcare insurance.
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Advice to Jobseekers
I don't think managed care is going away soon so I think it is a
field that will have opportunities in the future. The
environment is fast paced and lean on FTE's so everyone works
hard. Since I love what I do, my advise would be to consider a
position in this field, but it isn't for everyone.
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