Supervisor, Utilization Management Coordination (Inpatient or Pre-Service) (Finance)
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Supervisor, Utilization Management Coordination, under the direction of the Manager of UM, is responsible for ongoing management of the UM Department, including the oversite of clinical support concurrent review and preservice processes. Directly supervises coordinator staff performing UM duties. Accountable for promoting quality patient care outcomes while supporting appropriate resource management along the continuum of care and responsible for auditing and completing reports to meet CMS compliance requirements.
Job Duties/Responsibilities:
Supervises and supports the UM Coordinators' daily activities. Provides mentoring and ongoing training of staff to enhance performance. Manages departmental UM Coordinator activity and ensures appropriate staffing levels and scheduling to meet department KPI's (Key Performance Indicators) and OKR's (Objectives and Key Results). Collaborates with the clinical team and clinical leadership to address concerns and operational gaps in day-to-day activities. Supports and mentors the UM Coordinator team. Handles caller and case escalations and resolves as needed. Serves as subject matter expert (SME) for non-clinical authorization activities within the utilization management department. Conducts quality call monitoring audits and case file audits with clinical leadership to coach performance and identify additional training needs. Provides support to UM Coordinator team through regular monthly coaching sessions and team meetings. Manages special projects and allocates resources as needed. Collaborate with Network management team, Account Managers and Sales teams to gather feedback to enhance service performance. Participate in activities designed to improve member and client satisfaction and business performance. Works with UM Manager and/or Director to identify performance improvement initiatives and executes strategies accordingly. Support projects and other departments in completing tasks when directed by management.
SUPERVISORY RESPONSIBILITIES:
Oversee assigned staff. Responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.
JOB REQUIREMENTS:
Experience:
Required:
- Minimum (1) year recent and related supervisor experience
- Minimum (2) years related experience in a managed care setting, which includes inpatient and preservice utilization management
Education:
Required:
- High school diploma
Preferred:
- Medical Assistant or certificate in Medical Terminology
Specialized Skills:
Required:
- Knowledge of CMS regulatory requirements
- Computer Skills: Word, Excel, Microsoft Outlook
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $58,531.00 - $87,797.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/ . If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email careers@ahcusa.com .
