Financial Quality Management Project Manager

SUMMARY: The Financial Quality Management (FQM) Project Manager is primarily responsible for the timely analysis of work flow, policies, procedures, processes, reporting and decision tools, including the review of all business information to ascertain internal control areas of financial risk, with an ability to distinguish accompanying operational and compliance issues.  May manage allocated FTE work load, inclusive of quality control and training for any discovered deficiencies.  Under limited supervision, the position entails periodic reporting of internal performance to management, and provides both innovative strategic analysis and recommendations to executive management.  The FQM Project Manager will prepare routine and ad-hoc reports, perform monitoring as needed of process improvement activities, and keep management informed of deviations from planned strategies and/or outcomes.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

 

 

1.  Devise formalized work plans for financial quality management reviews of departments, internal units and their accompanying functions and processes.

 

2.  Implement financial quality management reviews, evaluating the targeted process or broader business unit for optimal financial performance, vis-?-vis operational and compliance issues.

 

3.  Research identified discrepancies and/or deviations from strategic internal process to ensure that a 360-degree view of any identified issue is well documented and communicated to management.

 

4.  Document findings and recommendations in a formalized assessment  reporting format. 

 

5.  Provide substantiating data and analysis to executive management in support of any findings.

 

6.  Present conclusions to management clearly, concisely and timely.

 

7.  Maintain a master project plan, including appropriate timeframes, of areas for review.

 

8.  Follow through with identified timeframes for project completion.

 

9.  Remain informed of best practices, including key performance indicators and financial benchmarks.

 

10. Stay current with relevant industry regulation and standards, and provide training to others as needed.

 

11. Participate and provide input in internal or external meetings. Interface with health plan and hospital personnel as requested and/or as needed.

 

QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual  must be able to perform each essential duty satisfactorily in a deadline-oriented environment.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

EDUCATION and/or EXPERIENCE:

Bachelor?s degree in accounting or finance or related field; MBA preferred; CPA desirable; 5+ years relevant experience in financial quality management, assurance, risk analysis, or a similar quality improvement environment preferably in a medical group practice management setting. In depth experience with professional capitation, claims, financial quality incentive programs, clinical regulatory guidelines for medical groups, DMHC (AB1455), CMS and other relevant regulation and guidelines is required.  Working knowledge of the COSO framework is desired.

 

LANGUAGE SKILLS:

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.  Capability to devise and implement work plans and manage personnel effectively.  Ability to write routine and ad-hoc reports and correspondence.  Ability to speak effectively before groups of customers or employees of the organization.

 

MATHEMATICAL SKILLS:

Ability to work with mathematical concepts such as probability, statistical inference, statistically valid random sampling, and standard deviation. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. Ability to develop and interpret financial models, and extrapolate predictive and relevant financial scenarios and outcomes.

 

REASONING ABILITY:

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.  Ability to deal with problems involving several concrete variables in standardized situations.

 

OTHER SKILLS and ABILITIES:

Detail and deadline oriented with strong analytical and modeling skills.  Knowledgeable in formulating strategic plans of action and seeing those through to recommended and reported conclusions.  Firm understanding of HMO professional risk environment, inclusive of captivation, claims, eligibility dynamics, reimbursement methodologies, CPT and ICD-9 coding, and medical terminology.  Working knowledge of EZ-CAP system preferred.  Strong experience with the more detailed functions of MS Word, Excel, Visio, Access and Powerpoint.  Strong interpersonal skills are required.  Superior ability to recognize areas of sensitivity and application of the corresponding subtle approach, where necessary.  Ability to interact with all departments to ensure the appropriate sharing of information.  Advanced capabilities in planning, organizing, managing and communicating demanding requirements. 

 

 

To be considered for this exciting career opportunity, please send a current resume along with salary history to csilva@pwlink.com  or simply apply online!

 

Physician WebLink is proud to be an Equal Opportunity Employer!