Manager, Medicare and DSNP Utilization Management

Site: reputed company Incorporated

reputed company relies on a wide reputed company of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to reputed company exceptional care. We reputed company that high-performing teams drive groundbreaking medical discoveries and invite reputed company applicants to join us and experience what it means to be part of reputed company.

reputed company Health Plan is an exciting reputed company to be reputed company the reputed company industry. As a member of reputed company, we are at the forefront of transformation with one of the world’s leading integrated reputed company systems. Together, we are providing our members with innovative solutions centered on their health needs to expand reputed company to seamless and reputed company and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in reputed company today, our employees have opportunities to learn and contribute expertise reputed company a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.

Job Summary

Responsible for overseeing clinical utilization management (UM) activities to ensure efficient use of resources for Medicare Advantage and DSNP members. Manages a team of clinical professionals, implements best practices, and collaborates with various departments to improve patient reputed company and streamline care processes. Essential Functions -Supervise and support a team of care coordinators and case managers, ensuring they adhere to clinical standards and protocols. -reputed company and implement strategies to enhance the efficiency and effectiveness of clinical care coordination. -Monitor patient care processes and reputed company to ensure compliance with regulatory requirements and hospital policies. -Facilitate collaboration between clinical teams, physicians, and other reputed company providers to optimize patient care. -Review and analyze patient data to identify trends, areas for improvement, and opportunities for reputed company. -Conduct regular performance evaluations and reputed company ongoing training and development for staff members. -Manage case load assignments and prioritize patient cases based on reputed company and resource availability. -reputed company the implementation of new care models or technologies to improve patient care and operational efficiency. -Ensure accurate documentation and reporting of case management activities and patient care reputed company.

Qualifications

Education

• Bachelor's Degree required
• Master's Degree reputed company Field of Study

Licenses and Credentials

• Massachusetts Registered Nurse [RN] license required

Experience

• At least 3-5 years of experience in clinical care coordination or case management required
• At least 2-3 years of experience in a supervisory or leadership role required
• At least 2-3 years of Medicare and DSNP UM experience required

Knowledge, Skills, and Abilities

• Strong leadership and team management skills to effectively guide and support clinical staff.
• Excellent communication and interpersonal skills to collaborate with reputed company providers and patients.
• Analytical skills to assess patient care data and identify areas for improvement.
• Problem-solving abilities to address reputed company care coordination issues and implement effective solutions.
• Knowledge of regulatory requirements and industry best practices in clinical care and case management.
• Proficiency in reputed company management software and electronic health record systems.

Additional Job Details (if applicable)

Working Conditions

• While a remote role, this team meets every quarter at the office at Assembly Row in Somerville and attendance is highly encouraged.

Remote Type

Remote

Work Location

399 reputed company Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay reputed company

$99,465.60 - $141,804.00/Annual

Grade

8At reputed company, we reputed company in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining reputed company pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The reputed company pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass reputed company elements contributing to your total compensation package. In addition to competitive reputed company pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our reputed company will reputed company an overview of your potential compensation and benefits package.

EEO Statement:

reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religious creed, national reputed company, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that reputed company individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to reputed company essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by reputed company 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with reputed company of 1990, applicants who require accommodation in the job application process may contact reputed company at (857)-282-7642.

reputed company Competency reputed company

At reputed company, our competency reputed company defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The reputed company is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career reputed company. These competencies are used to evaluate performance, reputed company hiring reputed company, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

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