Join to apply for the Manager, Utilization Management role at Christian Care Ministry
1 day ago Be among the first 25 applicants
Join to apply for the Manager, Utilization Management role at Christian Care Ministry
The range for this role is $73,000 - $99,500
Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education. This role includes opportunity to receive an annual bonus target of 10% of annual eligible earnings. Actual bonus amounts are determined by length of time in role, individual performance, and organizational performance.
Interested candidates must be willing and able to work onsite full-time in our Orlando, FL or Melbourne, FL office.
The Mission
At Christian Care Ministry we believe that Christians can, and should, share in one another’s burdens. Through the use of Medi-Share, a healthcare sharing ministry for Christians, we cultivate that belief.
The Team
Everyone at Christian Care Ministry is in agreement with our Statement of Faith, which outlines our core beliefs. Although we aren’t perfect people, we are serving our perfect God to the best of our ability.
The Job
The Manager, Utilization Management oversees and develops staff to ensure individual and team performance and quality of work aligns to organizational objectives and the strategic direction of the department. This role will collaborate with department and multi-disciplinary clinical teams to facilitate positive member outcomes. The role will support implementation of strategies to achieve and maintain optimal wellness and will identify and support resolution of operational and technical challenges in the department. 5 years experience in utilization management operations in a health care industry required; Strongly prefer within a healthcare payer organization.
Essential Job Duties & Responsibilities
Provide clinical leadership within utilization management activities guiding design, evolution, and implementation of the operations related to the clinical review processes and service levels
Provide leadership and guidance to the team to include Workforce Management
Ensure 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 ADP the PTO/MPTO requests from team members
Reports to their immediate direct report, any and all impediments to a team member’s ability to work
Reports to their immediate direct reporting manager, regular performance feedback of each team member
Provide leadership and guidance to the team to include Quality Management
Ensures new-hire training and education on the 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 Dept
Provide leadership and guidance to the team to include 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
Assess performance goals and metrics against established benchmarks to assure direct reports and teams achieve business expectations
Identify 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
Provide oversight of the team’s higher complexity cases
Develop and maintain the workflows, policies and procedures that govern and guide staff activities
Collaborate with interdepartmental and interdisciplinary teams to achieve improved member outcomes
Manage conflicts and escalations, high profile cases, and ensures proper notification of high dollar cases
Assist senior leadership in the screening and hiring process for team members
Ensure professional communication and collaboration within the team
Identify for design, and ensure execution of key team processes that foster interdepartmental and interdisciplinary collaboration for improved member outcomes
Provide input to senior leadership to maintain vendor relationships, process improvement, and system integration
Contribute to the exercise and expression of Christian Care Ministry’s Christian beliefs
All other duties as assigned
Essential Skills & Abilities
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
Core Competencies/Demonstrable Behaviors
Ensure Accountability – hold self and others accountable to meet commitments
Collaborates – builds partnerships and works collaboratively with others to meet shared objectives
Communicates Effectively – develops and delivers multi-mode communications that convey a clear understanding of the unique needs of different audiences
Directs Work – provides direction, delegates, and removed obstacles to get work done
Courage – steps up to address difficult issues, says what needs to be said with respect and authority
Education And/or Experience
Bachelor’s degree in a healthcare or other related field, OR equivalent combination of education and experience required
5 years experience in utilization management operations in a health care industry required; Strongly prefer within a healthcare payer organization
Prior experience in a leadership role managing teams required
Strongly prefer health care payer, operations, and change management expertise
Supervisory Responsibilities
This job has supervisory responsibilities for 7-10 clinical support employees.
Incentives & Benefits
We work hard to serve our Medi-Share Members, but know we can only do that if we invest in our employees professionally, financially, physically, socially, and spiritually. We purposefully invest in our employees so that our employees can invest in others.
For full-time employees working 30 hours or more, some of our benefits include, but are not limited to:
100% paid Medical for employees/99% for family
Generous employer Health Savings Account (HSA) contributions
Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance
6 weeks of paid parental leave (for both mom and dad)
Dental - two plans to choose from
Vision
Short-term Disability
Accident, Critical Illness, Hospital Indemnity
401(k) – up to 4% match on ROTH or Traditional contributions
Generous paid-time off and 11 paid holidays
Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo
Employee Assistance Program including no cost, in-person mental health visits and employee discounts
Monetary Anniversary Awards Program
Monetary Birthday Awards
Seniority level Seniority level Not Applicable
Employment type Employment type Full-time
Job function Job function Other
Referrals increase your chances of interviewing at Christian Care Ministry by 2x
Get notified about new Clinic Manager jobs in Orlando, FL .
Orlando, FL $58,800.00-$105,000.00 1 month ago
Intake Manager - Not for Profit Dialysis Organization Altamonte Springs, FL $40.00-$45.00 2 weeks ago
Registered Nurse Care Manager - Case Management - Bayfront Hospital - St. Petersburg, Florida Care Manager RN Optum at Altamonte Springs Altamonte Springs, FL $58,800.00-$105,000.00 1 month ago
Assistant Nurse Operations Manager - Administrative Supervisor Team - ORMC - Days Four Corners Clinical Assistant Nurse Manager, Full-Time Days Assistant Nurse Operations Manager - Wiregrass Ranch Hospital - Wesley Chapel, Florida Assistant Nurse Operations Manager - Pre-OP/PACU/OR/CathLab/Endo - Horizon West Assistant Nurse Operations Manager - Emergency Department - ORMC Assistant Nursing Operations Manager (OP)- Outpatient Cardiology - East Orlando, North Downtown, and Waterford Senior Nurse Manager Med Surg Medical Unit 2 RN Supervisor Neurology at Innovation Tower Nursing Operations Manager - PCU Full Time Clinical Assistant Nurse Manager - ER Full Time Nights Manager, Advanced Practice Provider-Cardiac Critical Care We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.