UM Intake Ops. Manager
Company: Emblem Health
Location: New York
Posted on: August 7, 2022
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Job Description:
Summary of Position--- Responsible for the direct supervision
and oversight of the intake team and its strategic goal of ensuring
appropriate/timely access of member benefits. --- Supporting
members of the managed long term care interdisciplinary care team
with responsibility for problem solving the execution of the
non-clinical aspects of a participant's care and ensuring
continuous process improvement. --- Responsible for planning,
analyzing, documenting, implementing and overseeing the daily
operation of the call centerPrincipal Accountabilities---
Responsible for the execution of efficient departmental processes
designed to manage the UM Intake call center, which includes
compliance with all internal and external call center relates
service levels, as well as appropriate member/provider medical
benefit access. --- Responsible for the supervision of the
non-clinical staff intake call center team, ensuring the timely and
appropriate execution of daily call center volume/inventory. ---
Develop, monitor, and communicate performance expectations and
plans for all direct reports; conduct performance reviews; provide
feedback on a regular basis; assist with resolution of employee
performance issues. --- Coach and mentor supervisors to ensure
understanding of utilization management concepts and effectively
apply the concepts to managing members' health care needs. ---
Ensure that staff adhere to the proper entry and maintenance of
documentation in the Medical Management and Service Cloud platforms
meeting defined timeframes and performance standards, including the
communication of decisions and important benefit information to
providers in accordance with applicable federal and state
regulations, and NCQA and business standards. --- Maintain an
environment of quality improvement through continuous evaluation of
processes and policies. Identify and recommend new technologies and
process efficiencies. --- Track and report statistics on call
intake activities, process measures (e.g. timeliness), quality
results, and other measures that affect departmental objectives.
--- Interact with various departments throughout the organization
and contribute to the resolution of interdepartmental issues. Lead
and develop team to quickly assess and diagnose root causes to
problem areas. --- Ensure compliance with State, Federal and NCQA
requirements related to utilization management case-set up
activities. --- Actively participate on assigned committees and
projects. --- Perform other duties as assigned.Education, Training,
Licenses, Certifications--- Bachelor's degree in Healthcare,
business or communications.Relevant Work Experience, Knowledge,
Skills, and Abilities--- 5 - 8 years of related work experience,
preferably in a customer service call center. --- 5 + years of
managed care experience, preferably in a supervisory or managerial
role. --- Additional years of experience or specialized
training/experience may be considered in lieu of educational
requirements. --- Prior supervisory experience. --- Strong
interpersonal skills --- Knowledge of care management regulations
and tactics. --- Strong oral and written communication and
interpersonal skills. --- Strong organizational skills. --- Strong
knowledge of Microsoft Office products including Word, Excel, and
Access.Additional Information Requisition ID: 1000000440
Keywords: Emblem Health, New York , UM Intake Ops. Manager, Executive , New York, New York
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