Medicare Utilization Management Supervisor

Site: reputed company Health Plan Holding Company, Inc.

reputed company relies on a wide range 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 provide 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.

reputed company Health Plan is an exciting reputed company to be reputed company the healthcare industry. As a member of reputed company, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless 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 healthcare 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 options, career growth opportunities, and much more.

Job Summary

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 direct coaching, supervision, and evaluation of licensed clinical staff. The supervisor may be required to participate in projects 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. -Educate staff on quality review requirements and documentation guidelines, with emphasis on highly accurate and specific documentation consistent with national regulations and practice. -Monitor individual productivity and adjust assignments as needed to support productivity goals, ensure quality 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 quality of work, making readjustments to align with MedAdv regulations and reputed company Health Plan 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 Nurse (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' core brand principles of always listening, challenging conventions, and providing value.

Additional Job Details (if applicable)

Working Conditions

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$99,465.60 - $141,804.00/Annual

Grade

8At reputed company, we reputed company in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining reputed company pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The reputed company pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass reputed company elements contributing to your total compensation package. In addition to competitive reputed company pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our reputed company team will provide an overview of your potential compensation and benefits package.

EEO Statement:

8925 reputed company Health Plan Holding Company, Inc. is an Equal Opportunity Employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, 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 Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with reputed company of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

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 each job level. The reputed company is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, reputed company hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

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