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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing health management operations, ensuring compliance with contract deliverables, and leading strategic planning initiatives. Proficient in medical coding, utilization management, and stakeholder relationship management.
Highest-signal resume keywords
RN LicenseMedical CodingUtilization ManagementProject ManagementStakeholder Relationship Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ManagementBillingPrior AuthorizationICD-10 CodingCMS ComplianceBudget MonitoringProcess ImprovementQuality ImprovementMedical Necessity ReviewsURAC Accreditation
Soft Skills
LeadershipCoachingConflict ManagementStrategic PlanningTeam Guidance
Industry Keywords
Health ManagementContract ManagementNCQA AccreditationStakeholder EngagementFast-Paced Environment
About the role
Key responsibilities & impact- Manage day-to-day operations of multiple and diverse health management lines of service and/or contracts/programs
- Lead strategic planning, implementation, evaluation, and ongoing management to meet contract deliverables, program requirements, and evaluation metrics within budget
- Facilitate analysis and action plans when deliverables or requirements are at risk
- Develop and maintain stakeholder relationships
- Provide technical assistance, issue research, and resolution
- Develop and implement continual process improvement methods
- Facilitate national programs/projects as assigned
- Ensure timely, satisfactory, and compliant operations within budget
- Participate in sales, business development, and proposal activities
- Monitor budgets and financials for assigned contracts
- Coach, guide, and direct team members
- Provide resources and support to meet departmental, company, and contract/program goals
- Represent the company and present at meetings and conferences
- Work externally with providers or clients as assigned
- Recommend improvements and efficiencies to management
- Support knowledge, skill development, and certifications related to quality improvement activities
- Stay current with industry trends and changes
- Supervise program staff and provide technical guidance and training
Requirements
What you’ll need- Four-year degree in nursing with a current Iowa RN license or the ability to become licensed in Iowa
- 5 years of experience in medical coding and utilization management, including claims, billing, prior authorization, and appeals
- 3–5 years of experience managing projects and professional staff
- Experience working in a fast-paced, deadline-driven environment
- Experience with URAC and NCQA health plan accreditation specific to utilization management
- Experience with claims post-pay medical necessity reviews
- Experience reviewing medical codes for coverage determination, medical policy, utilization management, evidence-based coverage determinations, and code update implementations including ICD-10 and CMS
- Knowledge of leadership principles, strategic planning, implementation and evaluation, leading change, coaching, guiding and training, and conflict management
- Knowledge of financial principles including budgeting
- Building and maintaining stakeholder relationships
- Specific contracts may require U.S. Citizenship
Benefits
Comp & perks- General benefits and other compensation are available in Telligen's Benefits Summary
- 100% employee-owned company with employees sharing in company success
- Equal Opportunity Employer
- Reasonable accommodations during the employment process