At Stony Brook Medicine the Director of Enrollment provides leadership and management of the Managed Care Enrollment Department at Stony Brook Medicine. He/She will oversee and coordinate managed care enrollment operations for Stony Brook Medicine and as part of the clinically integrated network (CIN). The individual will direct the activities of the Enrollment Staff and assist the team Administrators, the Departments and the Chairman in ensuring consistency throughout the enrollment process. The Director of Enrollment oversees the information system for enrollment staff and its interface with other information systems throughout Stony Brook Medicine and the CIN. The Director of Enrollment will be responsible for establishing appropriate enrollment policies for the health system, which includes the CIN, and will monitor performance to ensure that providers are enrolled as dictated by hospital bylaws. The Director of Enrollment will continuously review policies and operations of the health system and CIN to enhance and streamline the enrollment process and ensure continued compliance with regulatory agencies and adherence to NCQA standards for credentials in managed care.
The Director of Enrollment reports directly to the Assistant Director of Managed Care at Stony Brook Medicine.
Duties of a Director of Enrollment may include the following but are not limited to:
Assumes the leadership role in the area of provider enrollment and will interact with all levels of management within the health system and CIN as well as externally (managed care organizations, accrediting agencies, etc.)
As a subject matter expert, the Director of Enrollment oversees enrollment operations including month end reporting for Stony Brook Medicine and it's CIN; tackles large, complex business processes and transactions; plays a critical role in forecasting processes; ensures accurate and timely information for leadership; ensures compliance with regulatory agencies and health system policies. Responsible for aligning the business strategy and standardized methodologies and processes at macro level to the initiative level throughout the health system and its CIN.
Communicate effectively. Routinely provide others with the information they need to do their jobs. Effectively and consistently to superiors, peers, and employees.
Sets goals, motivates and aligns the organization. Inspire staff and generates a commitment to program and project goals.
Takes the initiative to solve problems and make decisions.
Builds relationships and fosters teamwork throughout Stony Brook Medicine and the CIN. Demonstrate the ability to build relationships across the health system and teamwork within the health system.
Creates a learning environment throughout Stony Brook Medicine and the CIN; Develop staff through mentoring, continued education, and providing an opportunity to learn new skills.
Respect diversity and practice inclusion; Ensure is compliant with federal and state regulations, foster a culturally diverse environment. Demonstrate cultural competence in interacting with team members and clients/patients.
Manage change, adapt to new challenges, embrace change, keep Stony Brook Medicine and CIN staff informed of changes and the impact to the department and/or health system, prioritize and meet project deadlines.
Develops and approves policies for the department, Stony Brook Medicine and the CIN.
Uses critical thinking, scientific inquiry, and other high-level processes to analyze complex problems. Uses a multidimensional knowledge base to seek ideal solutions.
Uses complex data from systems, quality improvement initiatives, and other sources to direct and enhance the ongoing work of the department, Stony Brook Medicine and the CIN.
Manage Service Excellence; Ensure employees deliver excellent customer service. Employee treats customers (guests, patients, clinicians, and all other employees) with courtesy, respect, and caring behaviors.
Manages Operations throughout Stony Brook Medicine and the CIN; Develops and implements work plans and measures against established standards. Proactively monitors key performance indicators and makes real-time adjustments to ensure goal accomplishment. Consistently seeks to improve work processes, evaluate workflows, and improve workflow efficiencies.
Capability to interpret industry trends and analyze data possesses critical thinking skills to identify a corrective course of action. Monitors financial performance of their area of responsibility and ensures responsible use of resources.
If and when the health system decides to pursue CVO certification, develop, manage and monitor the corporate and enterprise CVO program. Ensure program aligns with the strategic mission of Stony Brook Medicine and the CIN. Oversee the operations of the CVO to ensure compliance with regulatory and accreditation bodies. Develops short and long-term goals and measures for CVO performance and is accountable for ensuring that performance is improved to reach these goals. At the appropriate time, leads the process of attaining NCQA certification.
Plans work schedules, develop policies, procedures, standards, and workflow to ensure the efficacy of the program
Oversees the general operations of the Enrollment Office, Stony Brook Medicine and the CIN as it relates to enrollment.
Demonstrate the ability to have sound judgment and make appropriate decisions.
Coordinates and administers all aspects of the health care delegated plan enrollment process. Responsible for maintaining compliance for delegation oversight and credentialing.
Bachelor's Degree in Healthcare Management or related field and a minimum of 5 (five) years direct supervisory experience in an enrollment position, management credentialing position or CVO (Contracted Verification Organization).
Minimum of 5 year's supervisory/managerial experience
Exercise independent judgment in interpreting NCQA, TJC, CMS and State Laws and regulations as they pertain to credentialing
Experience with Credentialing Accreditation by NCQA
Proficient in CACTUS or similar program and Microsoft Office Suite
Eager to embrace the challenges and opportunities to lead the Enrollment team in a rapidly evolving environment
Passionate about playing a key role in changing the current healthcare environment
Ability to interact with internal and external customers and team members
Demonstrates ability to lead, manage and motivate teams
Flexible and adaptable in regards to learning and understanding new technologies
Highly analytical and detail-oriented with ability to demonstrate command of details and articulate those details at a higher level
Strong written, oral and interpersonal communication skills
Highly self-motivated, directed and proactive
Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment
Experience working both independently and in a team-oriented, collaborative union/non-union environment
Ability to communicate appropriately and effectively with practitioners and providers
Ability to problem solve and explore all options and to use available resources to find new and effective solutions
Master's Degree in Healthcare Management or related field with a minimum of 10 (ten) years of direct supervisory experience in an enrollment position, management credentialing position or CVO (Contracted Verification Organization).
Prior experience in developing a CVO.
NAMSS sponsored CPMSM or CPCS Certification
Special Notes: This position will remain posted until filled or for 90 days max.
An initial review of all applicants will occur two weeks from the posting date. For full consideration, applications must be received before the initial review date (which is within two weeks of the posting date). If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position; however, the posting will close once a finalist is identified, and at minimal, two weeks after the initial posting date. Please note, that if no candidate were identified and hired within 90 days from initial posting, the posting would close for review, and possibly reposted at a later date.
Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
All Hospital positions are subject to changes in pass days and shifts as necessary. This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
The selected candidate must successfully clear a background investigation. Prior to start date, the selected candidate must meet the following requirements: Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services (The hiring department will be responsible for any fee incurred for examination), submit (3) written references, and provide a copy of any required New York State license(s)/certificate(s). Please be advised that failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.
The best ideas in medicine start with the best people. At Stony Brook Medicine, our highest calling is to put the power of ideas to work in our patients' lives. Stony Brook Medicine integrates and elevates all of our health-related initiatives: education, research and patient care. Stony Brook Medicine is Long Island's premier academic medical center. With 603 beds, we serve as the region's only tertiary care center and Level 1 Trauma Center, and are home to the Stony Brook Heart Institute, Stony Brook Cancer Center, Stony Brook Children's Hospital, Stony Brook Neurosciences Institute, and Stony Brook Digestive Disorders Institute. We also encompass Suffolk County's only Level 4 Regional Perinatal Center, state-designated AIDS Center, state-designated Comprehensive Psychiatric Emergency Program, state-designated Burn Center, the Christopher Pendergast ALS Center of Excellence, and Kidney Transplant Center. It is home of the nation's first Pediatric Multiple Sclerosis Center.
Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.
This function/position has been designated as "essential." This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.
Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor's Office of Employee Relations at (518) 474-6988 or via email at firstname.lastname@example.org .
IF YOU NEED A DISABILITY-RELATED ACCOMMODATION, PLEASE CALL THE UNIVERSITY HUMAN RESOURCE SERVICES DEPARTMENT AT (631) 632-6161 OR THE UNIVERSITY HOSPITAL HUMAN RESOURCES DEPARTMENT AT (631) 444-4700. IN ACCORDANCE WITH THE TITLE II CRIME AWARENESS AND SECURITY ACT, A COPY OF OUR CRIME STATISTICS IS AVAILABLE UPON REQUEST BY CALLING (631) 632-6350. IT CAN ALSO BE VIEWED ON-LINE AT THE UNIVERSITY POLICE WEBSITE AT http://www.stonybrook.edu/police
Official Job Title: TH Senior Staff Associate
Job Field: Executive (Director & Above)
Primary Location: US-NY-East Setauket
Department/Hiring Area: Managed Care-Stony Brook University Hospital
Schedule: Full-time Shift: Day Shift Shift Hours: 8:30 am to 5:00 pm Pass Days: Sat, Sun
Posting Start Date: Jan 17, 2020
Posting End Date: Apr 17, 2020, 3:59:00 AM
Salary: Commensurate with experience
Salary Grade: SL5
Internal Number: 1904645
About Stony Brook University
FROM ITS BEGINNINGS A HALF-CENTURY AGO, STONY BROOK UNIVERSITY HAS BEEN CHARACTERIZED by innovation, energy and progress, transforming the lives of people who earn degrees, work and make groundbreaking discoveries here. A dramatic trajectory of growth has turned what was once a small teacher preparation college into an internationally recognized research institution that is changing the world.