Program Management Support

Sagility · United States · posted today ago

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About this role

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

The role of a Manager Operations is to contribute to the overall client satisfaction, retention and account profitability objectives by ensuring the operational performance standards for assigned accounts are met and enhanced.

Job title:

Program Management Support

Job Description:

Education:

College degree in Nursing Management, Marketing, Psychology or Life Science

Experience:

5 years customer service experience, 4-years managerial experience.

Mandatory Skills:

People Management/ Team Orientation
Drive for Results/ Execution
Expertise/ Analytical Skills
Product Knowledge
Problem Solving
Presentation Skills
Process Improvement
Fiscal Management
Business Acumen
Change Management
Planning, Organizing, Controlling

Roles & Responsibilities:

Responsible for translating client requirements into production floor activities.
Acts as the Supplier Program Manager/Senior Manager of Program Management.
Internal contact for the overall management and productivity of the operation.
Responsible for the management of specified supervisory teams, tracking of overall center efficiency, keeping updated on product and promotion information, providing Supplier Program Management with updates on service provided, and identifying and tracking improvement and value-added opportunities

Shift Management Function:

Monitor the teams’ daily performance on all metrics (customer satisfaction ratings, call handling times, service levels & quality grades) to ensure that standards are being met referring to a database, a program or reports.
Work with Senior OM in implementing programs, which are both clients, and in house.
Represents the site on client calls on specific area of discipline on a weekly basis or as scheduled for product/ system/ process updates best practices sharing, or call calibrations.
Attend weekly operations review and present action plans to issues that need to be addressed.
Execute data analysis specific to the team for action planning.
Collate and respond to operational issues as escalated/ needed.
Escalate operational issues beyond level of authority to the Senior Director for Operations – as needed.
Inform Senior OM when the system needed (system error/ downtime) to handle calls are not working effectively – as needed.
Submit weekly and monthly ops review report to the Senior Director for Operations.
Perform counselling to assigned Team Leaders and/ or Customer Service Associates for performance and/or discipline management.
Ensure Team Leaders’ shift coverage on a daily/weekly basis.
Approves/ disapproves request for unscheduled leaves and tardiness and do necessary adjustments to schedules of available manpower in order to meet requirements.
Participates in the development of contingency plans, escalation procedures, and disaster recovery plans.

Clinical Management Function:

Conducts clinical and critical thinking skills assessment of potential applicants for new hires and nursing academy scholars.
Takes escalated calls (Clinical Manager’s call) for the nurse triage line and preauthorization STAT/escalated transfers to resolve provider and member concerns that cannot be handled by frontline staff.
Follows through with pending pre-authorization requests (requiring supervisor’s assistance); reviewing client escalations on outcome of clinical reviews and case management enrolments

Quality Management/Standards Compliance Function:

Ensure team’s adherence to quality metrics and audit requirements – within and/or above standard compliance.
Ensure that Team Leaders are adhering to the monitoring requirement set forth.
Ensure that Team Leaders are calibrated in call monitoring.
Work with the Senior OM to further develop program and implement policy – as needed.
Work with the Team Leaders in coordination with other groups in coming up with programs that will help further develop the CSAs in delivering metrics.
Recommend new or modifications to existing procedures to ensure Continuous Process Improvement (CPI).
Evaluate management and contact center practices for possible modifications that will result in increased employee efficiency and satisfaction.
Reviews preliminary investigation of disciplinary cases and approves/disapproves/escalates disciplinary actions in adherence to the provisions of the Company Code of Conduct.
Participates in the preparation of the department’s annual business plan and budget to support HGS’ objectives and goals.
Implement action plans to ensure alignment between the other teams and/or support groups.
Analyze situation that arises outside the established guidelines or parameters and be able to evaluate such situation for impact on present guidelines.
Gives recommendations and implement these recommendations once approved to ensure process improvement in order to help the program achieve its goals.

Staff Development Function:

Provide daily leadership and motivation to a team of 7-10 Team Leaders.
Conduct monthly one-on-one coaching to Team Leaders and provide feedback to drive performance and reduce cost using data from reports on Attendance, handling time, productivity and quality grades.
Help Senior OM in creating incentives for all staff in conjunction with meeting performance measurements.
Conduct weekly meeting with Team Leaders and discuss team and program performance, issues and share best practices.
Design development plans for Team Leaders.Prepare for succession plan if in case the position got vacated in the future.
Initiate and support all employee satisfaction and workplace programs.
Consult personnel/ program issues to the Senior OM in terms of further decision making.
Conducts performance reviews and appraisals for Team Leaders (yearly). Provide immediate coaching regarding Team Leader or team performance when the need arises using documented personal observations or critical incidences to improve Team Leader and team performance.
Ensures timely and accurate communication regarding updates to Team Leaders.
Recommends and applies corrective measures for staff members who do not meet minimum performance metrics.
Works with Team Leaders to resolve concerns of CSAs as well as their own.
Able to follow-up personnel issues (e.g. Payroll, HR, etc.) as reported by Team Leaders.
Able to create specific Individual Development Plans for Team Leaders over a given period of time to prepare them to the next level.
Regularly spot-checks CSAs on customer handling and provides TLs/ Quality Personnel with feedback on areas for improvement.

General Safety and Security:

Protects the organization’s assets by upholding the principles of the Quality Information Security Management System (QISMS)
Ensures confidentiality, integrity, and availability of information critical to fulfilling the organization’s business functions
Remain compliant with the relevant business, local and international regulatory and legislative requirements particularly the Health Insurance Portability and Accountability Act of 1996 (HIPAA), HITECH Act and URAC.