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Program Management Specialist

2 months ago

Canton, Massachusetts, United States Ignyte AI Full time
Job Overview

Position Summary

Under the supervision of the Precertification Manager, the Program Management Specialist plays a crucial role in overseeing the daily operations of non-clinical evaluations that support the clinical, business, and programmatic functions of the department. This position is integral to the Utilization Management Team and serves as a representative of Ignyte AI values through effective written and verbal communication with both internal and external stakeholders.

Key Responsibilities

  • Initial Request Validation: Conducts preliminary reviews and triage of requests submitted through the authorization system.
  • Ensures that medical documentation is properly organized and assigned to the correct member.
  • Confirms member eligibility and benefit availability using relevant systems.
  • Identifies and manages special coverage and confidentiality requirements in accordance with established protocols.

Basic Coverage Assessments:

  • Adheres to coverage guidelines for specific request types, such as physical therapy or initial homecare, while monitoring benefit limits and restrictions.
  • Handles the complete process, including dispatching authorization information and letters to the appropriate providers and members.
  • Informs providers of member ineligibility and voids events as necessary, under the guidance of a Precertification reviewer.

Departmental Projects and Assignments:

  • Participates in various departmental initiatives and special projects to ensure compliance with strict processing deadlines.
  • Contributes to the documentation of workflows and procedures and provides training to colleagues as needed.
  • Cross-trains to manage requests for other teams within the Precertification department.

Qualifications

Education: An Associate's Degree or equivalent relevant work experience is required; a Bachelor's Degree is preferred.

Experience: A minimum of two years of experience in a business environment is required, with a preference for experience in managed care or the health industry.

Skills:

  • Exceptional verbal and written communication abilities.
  • Proficient and accurate in data entry across multiple applications.
  • Adept at identifying urgent situations and following established protocols.
  • Capable of managing multiple priorities while exercising sound judgment in a politically sensitive environment.
  • Strong organizational and problem-solving skills, with a keen attention to detail.
  • Excellent interpersonal skills, facilitating daily interactions with network providers and internal departments.
  • A collaborative team player, ensuring high-quality outputs that comply with regulatory standards.

Commitment to Diversity, Equity & Inclusion

Ignyte AI is dedicated to embedding diversity, equity, and inclusion into every aspect of our operations—from product development to workforce engagement. Our DEI strategy aligns with our core values and adapts to the evolving nature of work. We actively promote cultural awareness and provide training for leaders to engage effectively with their teams, while also establishing guidelines for recruiting and retaining diverse talent.

About Us

Ignyte AI is a prominent organization in health and wellbeing, committed to delivering personalized healthcare experiences to our communities. We build on the quality and nonprofit legacy of our founding organizations, leveraging our expertise to help individuals achieve their health goals through a comprehensive range of health plans and resources.