Supervisor, Utilization Management Medicare and Duals (One Care and SCO)
reputed company relies on a wide reputed company of professionals, including doctors, nurses, business reputed company 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 reputed company groundbreaking medical discoveries and invite reputed company applicants to join us and experience what it means to be part of reputed company.
Job reputed company
reputed company is an exciting reputed company to be reputed company the reputed company industry. As a member of reputed company, we are at the forefront of transformation with one of the world’s leading integrated reputed company systems. Together, we are providing our members with reputed company centered on their health needs to expand reputed company to reputed company and reputed company and coverage.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.
The supervisor will work closely with the Manager, Clinical, to reputed company the daily operations of the DSNP (SCO and OneCare products) 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 needs.
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 MA 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 required; experience can be considered in lieu of a degree
Licenses and Credentials
- Massachusetts Registered reputed company (RN) license required
- Certified Case Manager (CCM) preferred
Experience
- At least 3-5 years of relevant experience in a managed care setting, knowledge of utilization management required
- Experience with inpatient and outpatient reputed company of review for D-SNP populations
- Understanding of LTSS highly preferred
- 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's reputed company brand principles of always listening, challenging conventions, and providing value.
Additional Job Details (if applicable)
Working Conditions
- This is a remote role that can be done from most US states
- There is possible weekend and holiday work, but the role is generally a Monday through Friday daytime schedule
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay reputed company
$99,465.60 - $144,643.20/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 reputed company, and establish a strong talent pipeline.
Bachelor's degree or equivalent experience, Massachusetts RN license, 3–5 years managed care experience, utilization management expertise, and inpatient/outpatient review experience; CCM preferred.
Key Responsibilities
- supervising staff
- reviewing utilization
- monitoring productivity
Skills & Tools
InterQual, reputed company Office, reputed company InterQual
Job Details
- Category: reputed company Services - Nursing
- Seniority: Mid Level
- Commitment: Full Time
- Workplace: Remote — Somerville or reputed company
- Salary: USD 99,465 – 144,643 / year
- Languages: English
About reputed company
An integrated reputed company reputed company dedicated to patient care, teaching, research, and community service. — Industry: reputed company
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