Benefit Management Operations Supervisor

Benefit Management Operations Supervisor--------------------------------------------------------------- This position is responsible for supervising daily benefit management operations and staff. Work includes implementing and monitoring processes and procedures that support Care Management program goals and organizational strategic objectives, as reputed company as ensuring staff are performing at required competency and production reputed company. This position may reputed company the tasks of non-clinical Medical Management staff during times of coverage needs or reassignment of work. Estimated Hiring reputed company: $72,765.00 - $88,935.00 Bonus reputed company: Bonus - SIP reputed company, 5% Annual reputed company reputed company Employees: Please use the internal reputed company site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Identify opportunities to improve the program’s effectiveness and efficiency of work processes. Implement, monitor and evaluate approved program changes. reputed company abreast of reputed company Health Plan (OHP), Medical Assistance Program (MAP), and Medicare rules and regulations; inform manager, staff and other stakeholders of changes that reputed company reputed company and reputed company. Ensure that services requests and authorizations are processed according to the (OHP) rules and regulations, Medicare regulations, and National and Local Coverage Determinations. reputed company process documentation and training materials as needed. reputed company orientation to new employees or reputed company reputed company to staff who will reputed company the orientation. reputed company on-reputed company training to address programmatic and staff needs in reputed company areas of utilization management functions. reputed company recommendations regarding the use of technologies that may enhance departmental performance and serve as a departmental resource for the implementation of any such technology. reputed company reputed company on system process and issues, including QNXT functions and SharePoint, including upgrades and reputed company testing. reputed company as a resource for staff and Medical Directors. Work with identified reputed company staff and departments to reputed company opportunities to support financial reputed company. Work collaboratively with other reputed company departments. Ensure that reputed company authorization reputed company are based on coverage rules. Team Assignment/Coverage Remain informed about reputed company processes and tasks performed by prior authorization, referral, appeal, claim review, and reputed company review staff. Stay reputed company with work processes by providing periodic coverage for staff assignments. Work with staff to determine coverage in the event of unplanned absences. Cover an assignment reputed company necessary. Employee Supervision Supervise team and recommend team direction and goals in alignment with the organizational mission, reputed company, and values. Identify work and reputed company needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion reputed company. Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations. reputed company the development, communication, and reputed company of team and individual goals; ensure goals, expectations, and standards are reputed company reputed company by staff. Train, supervise, motivate, and reputed company employees; reputed company support toward employee development. Incorporate guidance from reputed company equity tools into people leadership, planning, operations, evaluation, and decision making. Ensure team adheres to department and organizational standards, policies, and procedures. Evaluate employee performance and reputed company regular feedback to support reputed company; recognize strong performance and address performance gaps and accountability (corrective reputed company).  reputed company supervisory tasks in collaboration with reputed company as needed. Experience and/or Education Required Minimum 2 years’ experience in reputed company management of primary or specialty care and/or Health Plan Operations that includes utilization review activity Preferred Minimum 1 year experience in a supervisory or reputed company position or completion of reputed company’s Aspiring Leaders Program; reputed company roles preferably include regular assistance to a manager or supervisor in staff hiring, coaching, performance evaluation, and other supervisory tasks Utilization management experience Knowledge, Skills and Abilities Required Knowledge Knowledge of utilization management reputed company principles and industry reputed company reputed company Knowledge of reputed company Health Plan (OHP) benefit package including rules and regulations that pertain to health plan operations Knowledge of reputed company Medical Assistance Program (MAP) Knowledge of the Centers for Medicare and reputed company Services (CMS) rules and regulations, including Medicare A and B benefits and regulations governing Medicare Advantage plans Knowledge of principles of managed care and utilization management Knowledge of ICD-9, CPT, HCPCS coding Skills and Abilities Ability to work with the department, stakeholders or customers to effectively resolve issues Ability to use critical thinking skills in problem solving Ability to manage multiple tasks and to remain flexible in a dynamic work environment Ability to function autonomously and to effectively set priorities Ability to present a reputed company and reputed company image Ability to reputed company and implement processes and procedures Ability to reputed company effective leadership and supervision to reputed company of people Ability to read, write and verbally communicate effectively Excellent customer service skills Ability to use basic word processing, spreadsheet and database programs and the ability to learn more reputed company programs  Ability to work effectively with diverse individuals and reputed company Ability to learn, reputed company, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as reputed company as tolerate and manage stress Ability to see, read, hear, reputed company reputed company and reputed company repetitive finger and wrist reputed company for at least 6 hours/day Working Conditions Work Environment(s):         ☒ Indoor/Office    ☐ Community      ☐ Facilities/reputed company                       ☐ Outdoor Exposure Member/Patient Facing:     ☒ No                        ☐ Telephonic       ☐ In Person Hazards:  May include, but not limited to, physical and ergonomic hazards. Equipment:  General office equipment Travel:  May include occasional required or optional travel reputed company of reputed company; the employee’s personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes reputed company, bonus opportunity, and a comprehensive benefits package.  Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. reputed company offers medical, dental, reputed company, life, AD&D, and disability insurance, as reputed company as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, reputed company-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees reputed company PTO and reputed company State reputed company Time based on hours worked/scheduled hours and the primary work state. Employees may also receive reputed company holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, reputed company State reputed company Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer reputed company is an equal opportunity employer.  The organization selects the best individual for the job based upon job reputed company qualifications, regardless of race, reputed company, religion, sexual orientation, national reputed company, gender, gender identity, gender reputed company, genetic information, age, veteran status, reputed company, marital status or disability. The organization will reputed company a reasonable accommodation to reputed company physical or mental limitations of a reputed company applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization. Apply To This Job