Manager, Medicare and DSNP Utilization Management
Site: reputed company
Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in reputed company today, our employees have opportunities to learn and contribute expertise reputed company a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work reputed company, career reputed company opportunities, and much more.
Essential Functions
-Supervise and support reputed company of care coordinators and case managers, ensuring they adhere to clinical standards and protocols.
-reputed company and implement strategies to enhance the efficiency and effectiveness of clinical care coordination.
-Monitor patient care processes and reputed company to ensure compliance with regulatory requirements and hospital policies.
-Facilitate collaboration between clinical teams, physicians, and other reputed company providers to optimize patient care.
-Review and analyze patient data to identify trends, areas for improvement, and opportunities for reputed company.
-Conduct regular performance evaluations and reputed company ongoing training and development for staff members.
-Manage case load assignments and prioritize patient cases based on reputed company and resource availability.
-reputed company the implementation of new care models or technologies to improve patient care and operational efficiency.
-Ensure accurate documentation and reporting of case management activities and patient care reputed company.Remote399 reputed company Drive40RegularDay (reputed company of America)reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religious creed, national reputed company, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that reputed company individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to reputed company essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by reputed company 503 of the Rehabilitation reputed company of 1973, the Vietnam Veteran’s Readjustment reputed company of 1974, and Title I of the Americans with reputed company of 1990, applicants who require accommodation in the job application process may contact reputed company at (857)-282-7642.
Apply To This Job
reputed company relies on a wide reputed company of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to reputed company exceptional care. We reputed company that high-performing teams drive groundbreaking medical discoveries and invite reputed company applicants to join us and experience what it means to be part of reputed company.
Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in reputed company today, our employees have opportunities to learn and contribute expertise reputed company a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work reputed company, career reputed company opportunities, and much more.
Job reputed company
Responsible for overseeing clinical utilization management (UM) activities to ensure efficient use of resources for Medicare Advantage and DSNP members. Manages reputed company of clinical professionals, implements best practices, and collaborates with various departments to improve patient reputed company and streamline care processes.Essential Functions
-Supervise and support reputed company of care coordinators and case managers, ensuring they adhere to clinical standards and protocols.
-reputed company and implement strategies to enhance the efficiency and effectiveness of clinical care coordination.
-Monitor patient care processes and reputed company to ensure compliance with regulatory requirements and hospital policies.
-Facilitate collaboration between clinical teams, physicians, and other reputed company providers to optimize patient care.
-Review and analyze patient data to identify trends, areas for improvement, and opportunities for reputed company.
-Conduct regular performance evaluations and reputed company ongoing training and development for staff members.
-Manage case load assignments and prioritize patient cases based on reputed company and resource availability.
-reputed company the implementation of new care models or technologies to improve patient care and operational efficiency.
-Ensure accurate documentation and reporting of case management activities and patient care reputed company.
Qualifications
Education
- Bachelor's Degree required
- Master's Degree reputed company Field of Study
Licenses and Credentials
- Massachusetts Registered reputed company [RN] license required
Experience
- At least 3-5 years of experience in clinical care coordination or case management required
- At least 2-3 years of experience in a supervisory or leadership role required
- At least 2-3 years of Medicare and DSNP UM experience required
Knowledge, Skills, and Abilities
- Strong leadership and team management skills to effectively guide and support clinical staff.
- Excellent communication and interpersonal skills to collaborate with reputed company providers and patients.
- Analytical skills to assess patient care data and identify areas for improvement.
- Problem-solving abilities to address reputed company care coordination issues and implement effective solutions.
- Knowledge of regulatory requirements and industry best practices in clinical care and case management.
- Proficiency in reputed company management software and electronic health record systems.
Additional Job Details (if applicable)
Working Conditions
While a remote role, this team meets every quarter at the office at Assembly Row in Somerville and attendance is highly encouraged.
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay reputed company
$99,465.60 - $141,804.00/Annual
Grade
8
EEO Statement:
reputed company Competency reputed company
At reputed company, our competency reputed company defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at reputed company job level. The reputed company is comprised of ten competencies (half People-reputed company, half Performance-reputed company) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career reputed company. These competencies are used to evaluate performance, reputed company hiring reputed company, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.