Job Description
Job Description
Job Title : Manager, Health Services
Mgt. Grade :
Department : Health Services Operations
Reports To : Health Services Senior Manager
FLSA Status : Management - Exempt
Summary :
The Manager of Health Services is responsible for the day-to-day operational oversight and management of the Patient Advocates and Patient Coordinators within the 32BJ Health Services Unit. The Manager coaches team members in problem solving techniques and intervenes in complex issues. The Manager monitors phone stats and staffing levels to ensure that Health Services calls are handled timely and appropriately. Additionally, the Manager is responsible for ensuring that staff follows all policies and procedures in order to meet the goals and objectives of the Department. The Manager assists and directs staff within the scope of the position and refers issues requiring a higher level of intervention to the Health Services Senior Manager or other staff as appropriate.
Principal Duties and Responsibilities :
- Assume leadership role in the direction, monitoring and support of the Health Services staff.
Interview, hire, evaluate, counsel and coach employees.
Identify opportunities for improvement and provide additional orientation and skill development on an ongoing basis.Provide guidance to staff regarding personnel-related conflict resolution.Ensure employee excellence through continuous evaluation of quality audit scores and oversee ongoing corrective actions and training to improve scores.Determine agenda items and hold staff meetings on a routine schedule to disseminate information, determine and resolve staff issues and provide direction to the Health Services staff.Ensure that all unit functions are staffed appropriately and that all unit processes are completed timely and accurately.Analyze all unit processes on an ongoing basis to determine their effectiveness, eliminate inefficiencies and makes changes to improve on identified inefficiencies.Ensure the overall continuity of case management activities, including but not limited to disseminating member cases from ACMP to staff, receiving approvals for out-of-network SNFs and LTACH requests, and monitoring and tracking case management-related issuesAssist staff in identifying in-network providers for membersConfirm true gaps in access to member’s medical care, communicate requests for in-network reimbursement for out-of-network providers and seek approval from Health Fund DirectorCoordinate responses to members regarding out-of-network services and services with increased member cost sharingAuthor policies and procedures to capture process change and revise current policies and procedures as necessary.Assist the Health Service Senior Manager with determining reporting needs.Oversee the generation of reports to continually evaluate the effectiveness of the Health Services Unit.
Maintain complete and accurate member communication statistics and report data to the Operations Director of the Health Fund.Intervene in complex cases that require management level intervention.Review complex claims cases surfaced from staff, and ensure all relevant information is detailed and summarized prior to escalating case to the Claims Analyst
Work directly with Claims Analyst to assess and resolve claims issues presented by members and providersCoordinate complex members benefits between the pharmacy vendor, dental vendor and the third-party administrator as neededOversees general functioning of a relationship with the third-party administrator’s case management clinical team and collaborates on :Primacy
Benefit related issuesSystem related case questions and issuesNegotiationsProblematic or escalated member issuesEstablish and maintain communication links with other areas of the 32BJ Funds to improve processes and service (i.e. Department of Eligibility, Member Services & Compliance Department).Qualifications :
To perform the job satisfactorily, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and / or ability required.
Technical Skills :
Ability to use Microsoft Office with emphasis on Excel and WordDemonstrated proficiency navigating Empire systems, and CRMExcellent organizational and prioritizing skills.Ability to work on simultaneous projects with diverse working groups.Interpersonal Skills :
Outstanding analytical and problem solving skills.Excellent verbal, written and interpersonal communication skills.Demonstrate the ability to lead and motivate staff.Excellent supervisory and coaching skills.Ability to effectively work in a fast-paced environment.Excellent listening skills.Outstanding work ethic and employment record.Ability to handle multiple tasks and prioritize appropriately in order to meet goals and objective of the department.Able to make critical decisions independently.Qualifications and Core Competencies :
Two plus years’ experience in a customer service or call center environment.Minimum of 3-5 years’ experience in the insurance industryProven track record in the supervision and management of staff.Strong knowledge base of the healthcare industry.Experience in healthcare policy research / claim analysis preferredWelfare / Trust Funds background preferred.Language Skills :
The ability to read, write and understand English is essential. Bilingual in English / Spanish is a plus.
Education :
BA, BS or Associates Degree or 5 years of related work experience
