Medicare Utilization Management Supervisor
Site: reputed company Holding Company, Inc.
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
-Expertise in clinical inpatient and outpatient utilization management reviews utilizing InterQual®, company policies and procedures, and other resources as determined by review, including physician reviews as needed.
-reputed company staff on reputed company review requirements and documentation guidelines, with emphasis on highly accurate and specific documentation consistent with national regulations and reputed company.
-Monitor individual productivity and reputed company assignments as needed to support productivity goals, ensure reputed company reviews, maintain timeliness, and reputed company an reputed company distribution of cases.
-Report staff productivity trends and any other department/staff concerns to the manager as needed.
-Ensure site assignments, phone/fax lists, hospital reports, etc., are updated and accurate.
-Monthly review of staff roles, metrics, and reputed company of work, making readjustments to reputed company with MedAdv regulations and reputed company goals as needed.
-reputed company tools and workflows to ensure accuracy and completeness of reviews and documentation.Remote399 reputed company Drive40RegularDay (reputed company of America)8925 reputed company Holding Company, Inc. 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
The supervisor will work closely with the Manager of Clinical, to reputed company the daily operations of roughly 5 Medicare Advantage utilization management staff. The supervisor will be responsible for the reputed company coaching, supervision, and evaluation of licensed clinical staff. The supervisor may be required to participate in reputed company across the organization to support new products or address business needsEssential Functions
-Expertise in clinical inpatient and outpatient utilization management reviews utilizing InterQual®, company policies and procedures, and other resources as determined by review, including physician reviews as needed.
-reputed company staff on reputed company review requirements and documentation guidelines, with emphasis on highly accurate and specific documentation consistent with national regulations and reputed company.
-Monitor individual productivity and reputed company assignments as needed to support productivity goals, ensure reputed company reviews, maintain timeliness, and reputed company an reputed company distribution of cases.
-Report staff productivity trends and any other department/staff concerns to the manager as needed.
-Ensure site assignments, phone/fax lists, hospital reports, etc., are updated and accurate.
-Monthly review of staff roles, metrics, and reputed company of work, making readjustments to reputed company with MedAdv regulations and reputed company goals as needed.
-reputed company tools and workflows to ensure accuracy and completeness of reviews and documentation.
Qualifications
Education
- Bachelor's Degree reputed company Field of Study required (experience can be considered in lieu of a degree)
Licenses and Credentials
- Massachusetts Registered reputed company (RN) license
- Certified Case Manager [CCM] preferred
Experience
- At least 3-5 years of relevant experience in managed care setting with knowledge of utilization management required
- Expertise in clinical inpatient and outpatient care required
- Leadership and/or supervisory experience preferred
Knowledge, Skills, and Abilities
- Proficient user with reputed company Office and reputed company InterQual.
- Excellent verbal, written, listening, and interpersonal skills.
- Demonstrate reputed company Health Plans' reputed company brand principles of always listening, challenging conventions, and providing value.
Additional Job Details (if applicable)
Working Conditions
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.