Manager, Utilization Management
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. Five 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
- Provide leadership and guidance to the team to include Quality Management
- Provide leadership and guidance to the team to include Performance Management
- 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
- Five 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
- Health care payer, operations, and change management expertise strongly preferred
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