Manager – Utilization Management

Manager – Utilization Management

Requirements

• Effective communication skill – able to motivate others to action and convey complex messages with simplicity in written and verbal form
• Leadership – proven ability to lead collaborative and high-performing teams effectively
• Operational skill – proven ability to provide operations support and direction to improve health outcomes for patients or members in areas of care, case, utilization, review, or general clinical management functions
• Expert knowledge of HIPPA, PHI, and PII rules and regulations
• Ability to work independently to meet deadlines and deliver high quality recommendations and work products
• Ability to navigate, lead, and implement change with direct reports, teams, peers, and leaders within the organization
• Ability to serve as a player/coach – leading and coaching others effectively while performing duties of the team and ensuring high levels of service to members is accomplished
• Training skill – ability to teach and develop new skills and ability in others
• Computer skill – ability to effectively navigate multiple software applications to document notes, track case load, extract reports, and interpret data
• Bachelor’s degree in a healthcare or other related field, OR equivalent combination of education and experience required
• 5 years’ experience in operations (health care industry, call center, or clinical health coaching) required; preferably in a healthcare payer organization
• Prior experience in a leadership role managing or coaching teams required

Responsibilities

• Provides leadership and guidance to the team in the area of Workforce Management
• Ensures staff are educated on their individual and team roles and responsibilities to carry out the ministry’s goals and objectives
• Daily evaluates and assigns the inflowing work to the team members
• Manages within our Human Resource Information System (ADP) time-off requests from team members
• Reports to their immediate direct reporting manager, any and all impediments to a team members’ ability to work
• Reports to their immediate direct reporting manager, regular performance feedback of each team member
• Provides leadership and guidance to the team in the area of Quality Management
• Ensures new-hire training and education on the Medi-Share Program Guidelines relative to health care, nursing, rehabilitative, and spiritual services to support the education of members
• Identifies opportunities for process-improvement within the team
• Performs audits to ensure that work follows proper process and documentation to meet quality and service-level agreements
• Ensures each team member remains up-to-date regarding knowledge and skills required for their position
• Ensures each team member is cross-trained to work within the Care Management Department
• Provides leadership and guidance to the team in the area of Performance Management
• Performs regular 1:1 meetings with each team member to give and receive regular performance feedback
• Develops and ensures accountability of performance goals, for their immediate direct reports and teams
• Develops performance metrics, for their immediate direct reports and teams
• Assesses performance goals and metrics against established benchmarks to assure direct reports and teams achieve business expectations
• Identifies staff and team members whose performance falls below expected goals and when appropriate, develops a plan of action in cooperation with the staff member to remediate
• Performs professional and performance coaching
• Develops and executes corrective action
• Provides oversight of the team’s higher complexity cases
• Develops and maintains the workflows, policies, and procedures that govern and guide staff activities
• Collaborates with interdepartmental and interdisciplinary teams to achieve improved member outcomes
• Manages conflicts and escalations, high profile cases, and ensures proper notification of high dollar cases
• Assists senior leadership in the screening and hiring process for team members
• Ensures professional communication and collaboration within the team
• Identifies for design and ensures execution of key team processes that foster interdepartmental and interdisciplinary collaboration for improved member outcomes
• Provides input to senior leadership to maintain vendor relationships, process improvement, and system integration
• Contributes to the exercise and expression of Christian Care Ministry’s Christian beliefs
• All other duties as assigned

Preferred Qualifications

• Prefer health care payer, operations, and change management expertise