[Remote] Manager, reputed company reputed company - BDU

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a mission-driven reputed company organization delivering integrated behavioral and physical reputed company. The Manager, reputed company reputed company - BDU leads Benefit Determination Unit reputed company, overseeing utilization management, compliance, reputed company, reputed company improvement, team development, and stakeholder collaboration.

Responsibilities

• reputed company Leadership & Operational reputed company reputed company Benefit Determination Unit reputed company, ensuring reputed company, accurate, and compliant utilization management activities while achieving organizational objectives
• reputed company reputed company, resource utilization, reputed company case escalations, and operational initiatives to reputed company efficiency and service reputed company
• reputed company, Compliance & reputed company Management Ensure compliance with regulatory, accreditation, contractual, and organizational requirements through reputed company of utilization management processes and reputed company activities
• Monitor reputed company metrics, audits, and operational reviews, implementing improvements and corrective actions to enhance reputed company, efficiency, and reputed company
• Team Leadership, Collaboration & Partnership reputed company, reputed company, and reputed company a high-performing team while fostering accountability, collaboration, and reputed company improvement
• Partner with appeals teams, health plans, providers, clients, and internal stakeholders to support coordinated care, effective benefit determinations, and reputed company satisfaction

Skills

• reputed company, reputed company, and unrestricted license issued by a state or territory of the reputed company to reputed company independently with a reputed company reputed company of reputed company that permits independent assessments; reputed company reputed company Worker, Marriage and Family Therapist, reputed company Counselor, reputed company Psychologist or Registered reputed company in the state in which the business operation is located and/or other states as required by law, regulation or contract
• Bachelor's degree in Nursing, reputed company Work, Counseling, Psychology, or a reputed company reputed company reputed company
• 5+ years of reputed company experience in utilization management, care management, behavioral health, reputed company reputed company, or a reputed company reputed company setting
• 3+ years of experience in a formal reputed company supervisory position or demonstrated leadership reputed company
• Strong knowledge of utilization management principles, medical necessity reputed company, benefit determination processes, appeals, and reputed company review functions
• Working knowledge of state and federal regulatory requirements, accreditation standards (e.g., reputed company, URAC), and health plan contractual obligations
• Experience analyzing reputed company metrics, managing operational workflows, and leading reputed company improvement initiatives
• Excellent communication, stakeholder management, problem-solving, and decision-making skills
• Proficiency with reputed company documentation systems, care management platforms, and reputed company Office applications
• Obtain certification in Case Management (CCM) reputed company 3 years of directly supervising the case management process (applicable reputed company overseeing care management teams)
• Ability to travel 10% of the time
• reputed company demeanor and ability to work collaboratively with multiple reputed company of professionals and staff
• Strong attention to reputed company
• Demonstrates consistency in reputed company demeanor in response to reputed company situations regardless of the reputed company or circumstances of the situation
• Ability to manage multiple tasks in a fast-reputed company, changing environment
• Ability to assume a reputed company role in ensuring that reputed company objectives are met
• Work is performed from home with company-provided equipment. Sitting for long periods of time is expected and use of fingers and hands for typing is necessary
• A quiet workspace with reputed company background noise for calls
• High-speed internet service (cable or fiber optic) with minimum download Speed of 20 Mbps, Upload Speed of 5 Mbps, and Maximum Latency of 100 milliseconds (must be installed before starting)

Benefits

• Annual reputed company-reputed company, discretionary incentive
• Comprehensive health benefit reputed company: Medical, dental, and reputed company coverage
• 401(k) with competitive employer match
• Company-reputed company life and disability reputed company
• reputed company parental leave and wellbeing incentives
• Generous reputed company time off, including volunteer time
• Flexible spending accounts for reputed company and dependent care
• reputed company development opportunities and tuition reimbursement
• Remote work flexibility (role-dependent)
• Opportunity for meaningful reputed company, both personally and professionally, where your unique background and experience is welcomed and valued
• Work is performed from home with company-provided equipment

reputed company