What are the responsibilities and job description for the Utilization Management Market Operations Manager position at CareSource?
Job Summary :
The Utilization Management (UM) Market Operations Manager is responsible for the operational activities of UM and Appeals for a specified line(s) of business managing the development of policies and procedures, review of team metrics, statutory reporting, overseeing committee reviews, audit preparation and presentations, and preparation and presentation of annual program requirements.
Essential Functions :
- Utilize process controls to achieve operational excellence in all areas within the department
- Actively work with clinical leadership in closing variances of operational procedures
- Oversee and support the development and maintenance of staff resources including but not limited to policies and standard operating procedures that ensure departmental alignment and adherence to contractual, state, NCQA, federal and other applicable guidelines
- Drive process improvement by utilizing continuous improvement frameworks
- Manage policy and process changes that result from regulatory / compliance requirements
- Educate, mentor, and train staff and clinical leaders on requirements, process improvement and quality
- Manage various relationships with both internal and external partners to improve standardization and interdepartmental collaboration on enterprise goals and initiatives
- Work collaboratively with appropriate departments to define and utilize outcome measurements in defining and driving success
- Design future state operation models that address opportunities
- Manage cross-divisional and cross-functional process improvement opportunities such as new business, systems and delegations
- Oversee and support change management initiatives that impact the department
- Perform any other job duties as requested
Education and Experience :
Competencies, Knowledge and Skills :
Licensure and Certification :
Working Conditions :
General office environment; may be required to sit or stand for extended periods of time
Compensation Range :
73,260.00 - $117,180.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type : Salary
Competencies :
TrueCare is a Mississippi non-profit, provider-sponsored health plan formed by a coalition of Mississippi hospitals and health systems throughout the state and supported by CareSource's national leadership in quality and operational excellence. TrueCare offers locally based provider services through provider engagement representatives and customer care. Our sole mission is to improve the health of Mississippians by leveraging local physician experience to inform decision-making, aligning incentives, using data more effectively, and reducing friction between the delivery and financing of health care. By doing so, TrueCare will change the way health care is delivered in Mississippi.
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
Salary : $73,260 - $117,180
