Utilization Management Coordinator, Supervisor

US-CA-Irvine
Req No.
2017-2173
Category
Clinical/Medical
Type
Regular Full-Time

Overview

ConcertoHealth delivers comprehensive care to Medicare, Medicaid, and complex-needs patients. For over a decade, we have provided extraordinary outcomes for thousands of people in these underserved groups.

The ConcertoHealth name reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. It’s about the harmony of a patient’s care, health, and dignity.

 

Supervises the daily operation of the non-clinical Utilization Management staff. Assist with ensuring consistent data collection from UM staff that is used to assist the company in achieving corporate goals, to improve monitoring and reporting to meet external requirements. Identify opportunities for process improvements necessary to facilitate department functions. Assist UM Manager with coordinating and facilitating system processes with providers, partners, vendors, and subcontractors as necessary. The UM Coordinator Supervisor serves as an active advocate for the members’ rights and plays a key role as a resource to the Medical Director/Manager of UM/CM.

Responsibilities

  • Supervise, coordinate, and coach the performance, quality, and regulatory requirements and activities of the non-clinical Utilization Management Staff.
  • Performs regular quality assurance audits of UMC staff including, phone call auditing, case handling and other non-clinical inter-rater reliability (IRR) activities as needed.
  • Assists with the daily operations of non-licensed professionals on the Utilization Management team.
  • Ensures that all activities are performed in accordance with established policies and procedures.
  • Coordinates with the UM/CM Manager to integrate clinical and non-clinical functions.
  • Determines priorities, assigns and regulates routine work performed by staff.
  • Provides coaching and counseling of staff members within Utilization Management.
  • Responsible for writing and finalizing annual reviews for direct reports.
  • Assesses candidates and ensures that optimal qualifications are met as a member of the department's interview team.
  • Plans, develops and supports or conducts orientations, training programs and creates educational material for staff members to improve skills, aid in professional growth and development and to ensure staffs expertise.
  • Participates in process reviews and the development of new and/or revised work processes, policies and procedures relating to Utilization Review.
  • Assists in the preparation of reports to track and analyze data for productivity and operations.
  • Conduct regular staff meetings and attend meetings as directed by the UM Manager and Senior Medical Director.
  • Acts as a liaison for outsides entities, including, but not limited to, physicians, hospitals, health care vendors, social service agencies, member advocates, and regulatory agencies.
  • Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity.
  • Establishes and maintains positive communication and professional demeanor with internal and external customers, providers and members at all times.
  • Stays current with Concerto Healthcare's policies and procedures, state and federal requirements and NCQA standards and recommendations impacting utilization management requests within the department.
  • Ensures a high level of collaboration with all departments.
  • Accepts other duties as assigned.

 

Qualifications

  • 3-5 years of experience in a healthcare, patient oriented customer service position required
  • Two (2) years of management experience, preferably within a managed care organization.
  • Direct experience in utilization management required.
  • Experience with management of Medicare/Medicaid benefits preferred.

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