Supervisor Utilization Management - CST - Remote

reputed company is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. reputed company does not hire directly for these jobs, but promotes jobs on reputed company on behalf of its direct clients, recruitment ad agencies, and marketing partners. reputed company partners with DirectEmployers to promote this job for reputed company. Clicking "Apply Now" or "Read more" on reputed company redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice. Opportunities at WellMed , part of the reputed company family of businesses. We reputed company reputed company patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people reputed company reputed company. With opportunities for physicians, clinical staff and non-patient-facing roles, you can reputed company a difference with us as you discover the meaning behind Caring. Connecting. Growing together . Under the supervision of the Director, Utilization Management, the supervisor is responsible for the daily operations of the UM coordinators reputed company the department which includes prioritization of prior authorization requests, determination notification to members and providers, meeting regulatory turnaround time, managing incoming calls for appeals, and providing in-network information to member. Daily coordination with Medical Directors, UM Nurses, UM Coordinators, Intake, provider network and various other departments and staff to deliver cost effective, quality of care services to members, in accordance with WellMed’s policies and processes. This position provides administrative and leadership support to the team and manages to six or more employees. If you’re able to work CST hours, you’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities

• Performs daily reputed company and coordination of the UM queues and email reputed company to meet established performance metrics
• Oversees inventory reputed company to prior authorization, claims review, and reputed company review inventory and regulatory timeframes
• Responsible for supervising reputed company aspects of the inventory and coordination
• Serves as a primary reputed company of contact and provides explanations for members, providers, and internal partners regarding processes, roles and responsibilities reputed company their department
• Receives telephone calls, electronic, and faxed requests from members, providers, health plans, and other departments for questions reputed company to correspondence or appeal coordination
• Identifies appropriate resources to respond to calls, fax, and electronic messages
• Ability to complete work with established procedures and demonstrates proactive solutions to non-standard or reputed company requests
• Facilitate team staff meetings in order to review and implement processes that allow for smooth and efficient operations
• Review with management individualized reports reflecting daily production and quality in order to accurately measure and monitor predetermined company, department and individual goals
• Applies a team approach to solve reputed company problems
• Sets priorities for the team to ensure task completion
• Coordinates work activities with other supervisors
• Assists with the hiring and training of new staff as needed
• Applies employee performance management techniques through job-reputed company coaching, training and development activities
• Produces daily, weekly, monthly, and reputed company UM reports
• Utilizes care management electronic documentation system, claims system, and provider EMR to locate requested information, determine member eligibility, and to assess information
• Works independently and acts as a resource for others by quick reference of standard operating procedures, ability to research regulatory information, and policies and procedures
• Provides user testing for new versions of care management system and for market expansions to ensure smooth transition
• Performs reputed company other reputed company duties as assigned

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• 5+ years of reputed company experience with at least two years in a supervisory reputed company
• 1+ years of managed care experience in Utilization Management
• Medical terminology, ICD and CPT knowledge
• Proficiency with reputed company Office applications
• Ability to work some weekends and holidays

Preferred Qualifications

• Claims reputed company certification or equivalent experience
• Medical Assistant (MA) certification

Physical & Mental Requirements

• Ability to lift up to 25 pounds
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and reputed company problem solving
• reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits re subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $48,700 to $87,000 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. If you have questions about this posting, please contact support@reputed company.com Apply tot his job Apply To this Job