Director of Managed Care

US-AZ-Mesa
Requisition ID
2017-1890
# of Openings
1
Nationwide Vision-Sightcare
Suite #101
Category
Operations
Position Type
Full Time
Schedule
Mon-Fri 8:30-5:00

Overview

The Vision Care Department of Nationwide Vision provides management of vision care insurance plan contracts and reimbursement processes, along with support of specialty vision care programs. The overall focus of the Director of Vision Administration is to play a critical role in supporting and meeting the company’s Vision Insurance business/sales goals through supervising and directing key support teams on the administrative side of the company. This position reports to the Vice President of Managed Care, and has fantastic growth potential.

Responsibilities

 

 

 

The Director will be responsible for supervising and managing the processes of the following teams:

  • Credentialing
  • Application
  • Call Support
  • Diabetic Management Programs
  • Skilled Nursing Facility

 

They will supervise and direct the following key areas of our affiliated vision insurance company, SightCare:

  • Partner with our IT teams in managing the following key system priorities: automated eligibility, web site claim submission, member explanation of benefits (EOB’s), automated broker/agent monthly commission and payment statements.
  • Work with our internal sales team to reach out to existing brokers/agents to generate additional sales through our SightCare plans.
  • Lead the sales team in recruiting new Providers to join our existing Provider Network.
  • Develop new marketing material to support brokers/agents in presenting our programs to various employer groups interested in providing vision insurance programs to their employees.

 

General Responsibilities:

  • Drive a culture of high performance and continuous process improvement within the department, while providing motivation and inspiration to team members.
  • Hire, train, develop, and communicate with staff, and provide them performance feedback. Offer professional growth and work on succession plans for departmental continuity.
  • Establish and develop trust and sound working relationships with corporate, retail, field management, and across the organization.
  • Support the alignment of vision insurance strategies through all of our retail brands. Ensure effective communication across the retail organization to increase sales under the plans.
  • Monitor the managed care environment nationally and regionally, keeping current on trends.

 

Qualifications

  • Bachelor’s degree in a business field or relevant major is preferred, or the equivalent work experience. A master’s degree in business or healthcare administration is a plus.
  • 5+ years of supervisory and management experience, preferably in a managed care or reimbursement environment.
  • 3+ years of experience in healthcare insurance benefits, claims administration and/or managed care systems is expected. Vision care/optical experience is a plus.
  • 3+ years of experience in a multi-unit retail optical chain environment is a plus.
  • Must be well-versed in Medicaid/Medicare claims administration.
  • Strong financial acumen and logical decision-making skills in business.
  • Solid project management skills and experience managing cross-team or cross-departmental projects.
  • Excellent written and oral communication, and coaching skills.
  • Solid understanding of HIPAA and other relevant regulations.
  • The individual seeking this role may not be on the government exclusion lists as determined by the Office of Inspector General (OIG) and System for Award Management (SAM).

Nationwide Vision is an equal opportunity employer. We value diversity and an inclusive, accessible workplace. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. Nationwide Vision is a drug-free work place. We participate in the E-Verify program. We screen against the OIG and SAM databases.

Nationwide Vision is an equal opportunity employer. We value diversity and an inclusive, accessible workplace. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. Nationwide Vision is a drug-free work place. We participate in the E-Verify program. We screen against the OIG and SAM databases.

US Vision is an equal opportunity employer. We value diversity and an inclusive, accessible workplace. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. US Vision is a drug-free work place. We participate in the E-Verify program.

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