Supervisor, Referrals and Utilization (AssociatesMD)
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We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all.
We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
Job Summary
The Supervisor, Care Navigation leads a team of utilization management case aides that are responsible for supporting Bright's utilization management function. The team will assist in the monitoring and coordination of authorization and appeal cases. Necessary actions may include data entry, case escalation, notification of determinations and care management referrals. The Supervisor position will provide guidance, training and oversight to a group of Case Aides as well as fielding Case Aide inquiries directly. This individual will serve as a role model for team members, assuring both members and providers have a positive experience with the services they receive. The Case Aide Supervisor, Utilization Management ensures all related initiatives meet all applicable state and/or federal regulatory requirements in addition to corresponding URAC standards.
Duties & Responsibilities
The Supervisor, Clinical Performance job description is intended to point out major responsibilities within the role, but it is not limited to these items.
(LICENSURES AND CERTIFICATIONS)
The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of NeueHealth, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all.
We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
Job Summary
The Supervisor, Care Navigation leads a team of utilization management case aides that are responsible for supporting Bright's utilization management function. The team will assist in the monitoring and coordination of authorization and appeal cases. Necessary actions may include data entry, case escalation, notification of determinations and care management referrals. The Supervisor position will provide guidance, training and oversight to a group of Case Aides as well as fielding Case Aide inquiries directly. This individual will serve as a role model for team members, assuring both members and providers have a positive experience with the services they receive. The Case Aide Supervisor, Utilization Management ensures all related initiatives meet all applicable state and/or federal regulatory requirements in addition to corresponding URAC standards.
Duties & Responsibilities
The Supervisor, Clinical Performance job description is intended to point out major responsibilities within the role, but it is not limited to these items.
- Provide leadership and direction to a team of Utilization Management Case Aids, inclusive of training and performance oversight.
- Support staffing and scheduling plans to meet departmental objectives as provided by leadership, including meeting specified service levels.
- Monitor operational key performance indicators to track service delivery against targets.
- Enforce UM policies and procedures to ensure compliance with state and federal agencies as well as accreditation standards.
- Support the development and maintenance of standard operating procedures related to corresponding program functions.
- Participate in the development of operating models to execute utilization management solutions.
- Other duties and responsibilities as assigned.
(LICENSURES AND CERTIFICATIONS)
- High School Diploma or GED required, bachelor's degree in a related field preferred.
- Three (3) or more years of supervisory experience within a consumer support function
- Two (2) or more years of healthcare related experience
- Prior experience with URAC accreditation is desired, but not required.
- Formal training in Six Sigma management techniques is desired, but not required.
- Approaches challenges calmly and objectively to identify the best solution.
- Capable communicator that can interact with others at multiple levels within the organization, customers, and providers.
- Leads through influence and example.
- Strong operational mindset and uses data to draw insights.
- Thrives on driving results in a collaborative environment.
The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of NeueHealth, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
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