What are the responsibilities and job description for the Remote - Non-Clinical Supervisor of UM - Utilization Management MLTC position at Compass Healthcare Consulting & Placement?
Compass Healthcare Consulting & Placement is conducting a search for an experienced Non-Clinical Supervisor of Utilization Management, for a role in the Utilization Management department of a growing Managed Care Plan, MLTC in New York. The position is fully remote, work from home. Qualified candidates will have prior NYS Managed Care Plan, MLTC experience as a supervisor, lead coordinator or lead medical specialist within Utilization Management, Clinical Quality, Authorizations, UAS Assessment and/or Care Management departments.
Non-Clinical Supervisor of Utilization Management
Under the supervision of the Director of Utilization Management/UM RN Supervisor the Utilization Management, the Non-Clinical Supervisor will assist with the development of reports, coordinating, tracking, training and day to day workflows related to authorizations to ensure all requests and inquiries are processed timely. Communicates with the Director of Utilization Management regarding any issues and concerns about, but not limited to, Utilization Management. Assists members in accessing services, resolving issues and communicating with other members of the Interdisciplinary Care Team. Participates in the development of regulatory reporting and compliance for the UM Non-clinical Department.
Essential Job Functions:
Authorization, coordination, fulfillment, reporting, monitoring and tracking of services covered by the plan.
Monitors that all authorizations are completed accurately and efficiently in a timely manner.
Facilitates contact with Case Management team, Care Coordinator team, Provider Relations, Intake, Enrollment, Member Services, Claims and external providers to meet member’s needs and support departmental business initiatives.
Provides support to the Case Management and Care Coordinator team in tracking, authorizing and delivering service requests.
Oversees the productivity and coverage of Care Coordinators on a daily basis.
Communicates performance issues to management and participates in performance evaluation.
Develops and participates in the new hire training program and any ongoing refresher education to the Utilization Management associates.
Facilitates meetings, coordinates the agenda, reviews and approves new workflows, maintains planning foresight and the work calendar.
Coaches each team member personally through one-on-one meetings where the team leader highlights the person's strengths and areas that need improvement and conducts on-the-spot teaching.
Responsible for the evaluation of staff performance.
Conducts all work in accordance with the confidentiality requirement mandated by HIPPA for member information including telephone service standards and turn-around times.
Compiles data for utilization management reports. Participates in the completion of regulatory reporting.
Completes compliance and quality audits. Contributes to the corrective action plan if deficiencies are identified.
Reports any member dissatisfaction and grievance as appropriate; Resolves same day complaints\grievances where possible.
Participates in special projects and performs other duties as assigned
Qualifications
Education: A minimum of formal education of Associate’s Degree.
A minimum of 2-3 years job-related experience in healthcare, medical office or facility setting with demonstration of medical administration duties.
Strong ability to solve problems independently and interact with an integrated team.
Strong multi-tasking abilities.
Exceptional skills of organization, communication, professional interaction, and human relation skills, as well as analytical skills required.
Thorough knowledge of medical terminology and/or experience with CPT, HCPCS and ICD-10 coding.
Advanced knowledge of navigating Uniform Assessment
System (UAS) and ePaces.
Advanced Microsoft Outlook proficient in Microsoft Office such as Outlook, Word and Excel.
Bilingual in Spanish, Russian, Creole, Chinese(Cantonese/Mandarin) is preferred
Competitive Salary & excellent benefits!
Qualified Candidates Please Apply Now for Immediate consideration!
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