To ensure effective communication, I would establish regular meetings and clear reporting channels between stakeholders. Utilizing technology like secure messaging platforms and shared dashboards can streamline information exchange. I would also implement standardized protocols for data sharing and ensure all parties are trained on compliance requirements. Building strong relationships through transparency and responsiveness is key to fostering trust and collaboration.

I stay updated by subscribing to industry newsletters, attending webinars, and participating in professional organizations like the American Association of Managed Care Nurses. I also regularly review updates from regulatory bodies such as CMS and state health departments. Networking with peers and attending conferences helps me gain insights into emerging trends and best practices in managed care.

In a previous role, I mediated a dispute over denied claims by facilitating a meeting between the provider and insurer. I reviewed the claims process, identified miscommunication in documentation, and proposed a solution to streamline future submissions. By fostering open dialogue and focusing on shared goals, we resolved the issue, improved collaboration, and reduced claim denials by 20%.

Success is measured through key performance indicators such as patient satisfaction scores, cost savings, and quality metrics like readmission rates. I also track claim approval rates, provider compliance with care protocols, and member retention. Regular audits and feedback from stakeholders help identify areas for improvement and ensure the program aligns with organizational goals.

I would start by analyzing current workflows to identify bottlenecks and inefficiencies. Implementing technology solutions like automated claims processing and predictive analytics can streamline operations. Training staff on best practices and fostering collaboration between departments ensures smoother execution. Regularly reviewing performance data and adjusting strategies based on feedback helps maintain continuous improvement.