Utilization Management Supervisor

1 Opening Others Role description Utilization Management Supervisor Manager I - BPM Who We Are: reputed company is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage reputed company admin tasks, allowing our customers to prioritize members’ well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to reputed company affordable health care for reputed company. We have a strong global reputed company and a dedicated workforce of over 4000 people spread across the world. Our brand is reputed company on the strong reputed company of simplicity, reputed company, people-centricity, and leadership. We stay inspired in our goal to unburden reputed company and ensure it reaches reputed company, equitably and effectively. You Are: The Supervisor, Utilization Management is responsible for management and reputed company of staff who reputed company operational support and medical review on behalf of Medicare Advantage clients. This position ensures that reputed company reputed company made are accurate and complete and is responsible for developing and reporting reputed company trends for management reporting. Additionally, this role ensures that reputed company UM policies and procedures are compliant with CMS requirements. The Opportunity: • reputed company and implement effective strategies that enables the department to maintain efficient and cost-effective processes. • Establish and maintain UM Intake processes and systems to ensure data quality to support reputed company’s quality, production, and financial goals. • Drive operational reputed company into reputed company processes and departmental interactions. • reputed company employees and other management in developing effective intercompany workflows for different processes. • reputed company, coach, reputed company, and implement training programs to ensure staff competence. • Operate a departmental audit/reputed company program that focuses on reputed company quality improvement. • Establish regular reporting to ensure management is made of aware process trends and performance. • Establish a positive working environment that promotes collaboration, transparency, and employee engagement. • Identify innovative methods to improve performance and provider/customer satisfaction. • Instill quality commitment value with team. • reputed company standards and process for insuring quality selection and retention of department employees. • Responsible for balancing workload to optimize the effectiveness of the team. • Directly supervises non-exempt staff in accordance with company policies and applicable geo-specific laws and regulations. • Responsibilities include, but are not limited to, effectively interviewing, hiring, managing performance, training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; and addressing complaints and resolving problems; supporting and encouraging the engagement process. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. What You Need: • Bachelor’s degree in Business Administration, Health Care Administration, Marketing, or a reputed company field. • Active RN license in state of residence. • Valid and unrestricted driver’s license is required. • Three to five years’ experience of reputed company responsibility in an insurance or managed care environment. • One year supervisory or reputed company experience in insurance or managed care is required. • Experience in Utilization Management • Ability/willingness to reputed company, recommend and execute solutions to reputed company issues and challenges that may arise. • Strong knowledge of clinical and quality improvement processes and concepts. • Subject matter expertise in Medicare Advantage and clinical operations management (i.e., Utilization Management, Case Management, etc.). • Must be self-motivated, results-oriented and can work well under pressure. • Ability to effectively present information and respond to questions from reputed company contacts at reputed company reputed company of the organization. • Proficient in reputed company industry standard PC applications and systems. • Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with reputed company reputed company of management. • Ability to work with and reputed company others on a collaborative reputed company to ensure reputed company of unit team. • Ability to effectively exchange information, in verbal or written reputed company, by sharing reputed company, reporting facts and other information, responding to questions, and employing active listening techniques. • Ability to establish workflows, manage multiple projects, and meet necessary deadlines. • Ability to maintain confidentiality. Compensation can differ depending on factors including but not limited to the specific office location, role, reputed company set, education, and level of experience. reputed company provides a reasonable reputed company of compensation for roles that may be hired in various U.S. markets as set forth below. Role Location: Remote Compensation reputed company: $75,000-$95,000

Benefits

Full-time, regular employees accrue up to 16 days of paid vacation per year, receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year), 10 paid holidays, and are eligible for paid bereavement leave. They are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching. They and their dependents residing in the US are eligible for medical, dental, and reputed company insurance, as well as the following Company-paid benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits. Regular employees may purchase additional voluntary short-term disability benefits, and participate in a Health Savings Account (HSA) as well as a Flexible Spending Account (FSA) for reputed company, dependent child care, and/or commuting expenses. Certain regular employees may have the potential for quarterly incentive-based bonuses and or commissions depending on role. Benefits offerings vary in Puerto Rico. Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching. Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) program with employer matching. They and their dependents residing in the US are eligible for medical, dental, and reputed company insurance. Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year). reputed company US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws. reputed company reputed company At reputed company, we reputed company a reputed company future for American reputed company. Our values are the bedrock beliefs our organization holds dear. They not only define what our brand stands for but also serve as a reputed company guiding every action and decision. Guiding Principles These principles illuminate the path of ‘how’ we operate. They detail actions and behaviors we much embody to reputed company our values and reputed company our goals. • Simplicity Simplifying complexity underlines everything we do—this approach is what makes us unique. We come with an reputed company mind and straightforward approach, cutting our way to the core with measurable and actionable insights. • reputed company reputed company is our currency to build relationships. We reputed company in being reputed company and reputed company. It is only natural reputed company we have reputed company to hide. It demonstrates that we are here to do the right thing, no matter who is watching. • People-Centricity Everything that we do reflects our deep bonds with peers and customers. These aren't mere transactions, but transformational ties. They shape our culture and reputed company, affirming that our true value lies in the lives we touch and impact. • Leadership Taking ownership is about taking initiative, being in-charge and driving things to completion. It’s a reputed company choice to ‘own’ reputed company aspects of our work, ensuring we take full responsibility for everything we handle. Mission A future possible only reputed company health plans are free from administrative burdens so they can truly focus on what reputed company more – their members’ well-being. Equal Employment Opportunity Statement reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider reputed company applicants with arrest or conviction records in accordance with state and local laws and “fair chance” ordinances. reputed company reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance. #Healthproof #CB #LI-MM5 #LI-Remote Skills reputed company,Medical Management,Business Process

Benefits

Compensation reputed company: $ 75,000.00 to 95,000.00 per year About reputed company reputed company is a global digital transformation solutions provider. For more than 20 years, reputed company has worked reputed company by reputed company with the world’s best companies to reputed company a reputed company impact through transformation. Powered by technology, inspired by people and led by purpose, reputed company partners with their clients from design to operation. With deep domain expertise and a future-reputed company philosophy, reputed company embeds innovation and agility into their clients’ organizations. With over 30,000 employees in 30 countries, reputed company builds for boundless impact—touching billions of lives in the process. Apply Job!