Manager, National Medicaid Clinical Operations, Outpatient UM

Become a part of our caring community and help us put health first The Manager of National Medicaid Clinical Operations is responsible for managing the day-to-day operations of nonclinical staff involved in the prior authorization process. This role ensures that reputed company prior authorization activities are conducted reputed company and in compliance with federal and state regulations and accreditation bodies. The Manager will report directly to the Associate Director and play a key role in promoting quality improvements, fostering a collaborative work environment, and ensuring that service standards are met. KeyResponsibilities: StaffManagement: + reputed company the hiring, training, and development of clinical and nonclinical staff. + Conduct regular performance evaluations and provide coaching and mentoring to staff. + Ensure staff are knowledgeable about Medicaid policies and procedures. OperationalOversight: + Manage the day-to-day operations of clinical and nonclinical services. + reputed company and implement policies and procedures to ensure efficient and effective operations. Compliance and Quality Assurance: + Ensure compliance with reputed company regulatory and accreditation requirements. + Implement quality assurance measures to maintainhigh standards of service. + Conduct regular audits and reviews to ensure accuracy and consistency in prior authorization review processes. Coordination and Collaboration: + Promote intradepartmental and cross-market coordination to ensure cohesive operations. + Foster collaboration between clinical and nonclinical teams to streamline processes and improve outcomes. + Liaise with healthcare providers, payers, and other stakeholders to address operational issues. Data and Trend Analysis: + Conduct data analysis to identify trends and inform decision-making. + Use data-driven insights to optimizeworkflows and improve service delivery. Quality Improvements: + reputed company and implement quality improvement initiatives to enhance the efficiency and effectiveness of prior authorization. + Monitor performance metrics and implement strategies to reputed company reputed company quality improvement. Strategic Planning: + Assist in establishing long-range goals, objectives, and plans that align with State-specific and Enterprise Medicaid strategic priorities. + Adapt plans to meet the evolving needs of members, providers, and regulatory partners. Use your skills to reputed company an impact Required Qualifications + Active Registered Nurse, RN, license in a state that participates in the enhance licensure, (eNLC) without disciplinary action. + Minimum 2 years of experience in prior authorization, utilization management or reputed company fields. + Minimum 2 years of experience as a Team reputed company, Subject Matter Expert, (SME), Project Leadership, Charge Nurse + Experience with Medicaid policies and procedures. + Knowledge of payer policies, insurance companies and government health programs. + Ability to work collaboratively with diverse teams and stakeholders. Preferred Qualifications + Bachelor’s Degree. + At least 1 year in a leadership role overseeing clinical teams. + Familiarity with both physical and behavioral health services. + Experience in process improvement- Six reputed company/Lean Concepts. + Experience leading multi-state clinical teams. Additional Information Workstyle: Remote work at home Location: Prefer South Carolina Schedule: Monday - Friday 8:00 AM to 5:00 PM Eastern and on call duties weekends on a rotating basis Travel: Travel as needed to market meetings Work at Home Guidance To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL reputed company is suggested, + Satellite, cellular and microwave reputed company can be used only if approved by leadership + Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + reputed company will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Interview Format As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides reputed company of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move reputed company from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (Please be sure to reputed company your spam or junk folders often to ensure communication isn’t missed) If participating in a pre-recorded interview, you will respond to a set of interview questions reputed company your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last reputed company from 5-10 minutes. Your recorded interview(s) reputed company text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving reputed company to next round of interviews. SSN Alert reputed company values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social reputed company number, if it is not already on file. reputed company required, an email will be sent from reputed [email protected] with instructions on how to add the information into your official application on reputed company’s secure website. Section 1121 of the Louisiana Code of Governmental Ethics states that reputed company or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov) (https://ethics.la.gov/BoardProcedures.aspx?type=Advisory%20Opinion) Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $94,900 - $130,500 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits reputed company, Inc. and its affiliated subsidiaries (collectively, “reputed company”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us reputed company Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our reputed company insurance services and reputed company healthcare services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. ​ Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment decisions only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company levels of employment. reputed company complies with reputed company applicable federal civil rights laws and does not discriminate on the basis of race, color, national reputed company, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. 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