Program Manager, Care & Clinical Denials Management

Job Description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary

Acts as a subject matter expert and point of contact for all related system products, data and education. Provides consultative, educational, and technical support services to the CMRC and departments that utilize the system tools. Maintains accountability for the design, implementation, and training of the departmental system for the organization. Partners with IT on technical related issues. Works with Intersect Healthcare (IHI) support, ensuring timely completion of upgrades. Analyzes, documents, and designs work and data flows and oversees all testing. Manages the installation of new and existing system workflows to include tables/dictionaries end-user training and suggests new job automations. Oversees the management reporting system to ensure all departments appropriately address organization priorities. Coordinates internal communications with system IHI support for hardware and software problem resolution. Utilizes data visualization tools to produce high-quality reports for CMRC, market and other departmental leadership.

Job Requirements

Education and Work Experience:

• Bachelor’s Degree in mathematics, statistics, computer science, economics, finance, health science or nursing, or equivalent combination of education/related experience: Required
• Master's Degree: Preferred
• Five years' relevant experience: Preferred
• One year leadership experience: Preferred
  
  

Essential Functions

• Acts as a main point of contact and subject matter expert for all users regarding support, training and reporting needs and as the liaison between the client and Intersect Healthcare (IHI).
• Researches, evaluates and makes recommendations on the need for new workflows or system enhancements to CRMC end-users, vendors, and management by evaluating existing operations and systems, including volumes, data flow, constraints, documents, reports, and impacts on the end-users.
• Performs maintenance in system tool to include general, user, task and payer maintenance. Manages workflow requests and subsequent maintenance.
• Documents, monitors, and communicates progress on identified issues, regulatory changes, and known requests for each workflow. Makes recommendations for changes to best impact the end-user.
• Develops reports using system ad-hoc reporting and train users or systemwide personnel in the use of ad-hoc reporting. Validates data and maintains dictionaries. Interprets and analyzes data to inform operational and strategic decisions.
• Performs other job-related duties as assigned.
  
  

Organizational Requirements

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.

About Us

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 90 communities on the West Coast and Hawaii with over 400 sites of care, including 26 acute care facilities, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of 37,000 includes employees, physicians and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.