What are the responsibilities and job description for the Manager Utilization Management Support Services position at Children's Wisconsin?
Join the team at Chorus Community Health Plans : Where passion meets purpose
Are you ready to make a difference? Do you believe in the power of health insurance to change lives? At Chorus Community Health Plans, we don't just offer jobs, we offer opportunities to be part of something bigger, something that matters. By Joining our team, you'll become a vital force in improving access to healthcare, promoting health equity and strengthening communities. Join us in our mission to make quality healthcare accessible to all.
About us
Chorus Community Health Plans (CCHP) is not just another health insurance company; we are a community committed to transforming lives. Founded in 2005, CCHP is a trusted health maintenance organization (HMO) based in Wisconsin. We are a part of Children's Wisconsin, one of the state's most respected healthcare organizations. At CCHP, our core values - Purpose, Collaboration, Health, Innovation, and Integrity - drive us to provide exceptional service to the individuals, children, and families we serve.
Our programs
- BadgerCare Plus : CCHP, the second largest BadgerCare health plan in Wisconsin serves over 130,000 adults and children in 27 counties in eastern Wisconsin.
- Care4Kids : We're the pioneers of Wisconsin's Foster Care Medical Home initiative, providing vital health care coordination services to 2,800 children in out-of-home care in Southeastern Wisconsin. Through our "medical home" model, we strengthen care quality, access, and timeliness, shaping healthier futures for these children.
- Individual and Family Plans : Tailored to meet the diverse needs of individuals and families in a 15-county service area, our plans serve more than 13,000 members. Our extensive network, including renowned institutions like Ascension, Froedtert, and Medical College of Wisconsin, ensures comprehensive coverage both on and off the exchange.
What we offer
Your opportunity
We invite dedicated individuals to join our mission-driven organization. Be a part of something where your skills and enthusiasm translate into meaningful change. Discover a career where your passion meets purpose. Apply today and help us shape a healthier tomorrow.
Please follow this link for a closer look at what it's like to work at Children's Wisconsin :
Provides oversight to the services and staff supporting the utilization management (UM) program to ensure the prior authorization process runs efficiently and effectively. Provides direct supervision to the staff supporting the UM program which includes authorization specialists, system support specialists, and staff dedicated to oversight of the UM software platforms. Oversees and leads all aspects of the UM software platforms (Guiding Care, MCG, etc.) and owns the operational relationship with those vendors. Collaborates with network providers to resolve authorization issues and ensure authorizations are not a barrier to members receiving needed health care services. Serves as an active member of the leadership team participating in daily operations, audits, process change and program development. Ensures UM policies are in compliance with NCQA and other regulatory bodies, and that UM support staff complete their work in accordance with written policies.
MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED :
Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and / or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.
