Under the direction of the Director of Utilization Management and Customer Service, this position is responsible to assist in the oversight of non-clinical staff's productivity and quality performance. Provide the audit and analysis of healthcare information as it relates to the Utilization Review department. The Administrative Lead will provide integrated reporting, data analytics, process improvement, department metrics and data integrity based on the collection, association review and the interpretation of data and operational processes. The Administrative Lead will interact with other departments, clinic personnel, and outside providers in a professional and friendly manner, to create and maintain a positive relationship with our internal and external customers.
1.1 Assist in the overall oversight of the department and staff as directed by the Director of UM.
1.2 Assist the Director of UM in process implementation, monitoring, auditing, and analysis of staff.
1.3 Assist with training, education, counseling and orientation of staff.
1.4 Assist with leading the staff by demonstrating a proactive approach, being flexible with change and/or development. 1.5 Capable of learning and understanding departmental processes to assist in implementing efficient and effective changesfor better performance and compliance.
1.6 Must be capable of multitasking, problem solving and make independent decisions.
1. 7 Must be capable of learning the use of the organizations data sources.
1.8 Must be capable of understanding with comprehension the regulations, policies, and procedures as they apply to departmental processes.
1.9 Ability to learn to critically evaluate information gathered from multiple sources and assist with reconciling issues.
1.1 O Responsible for auditing, reviewing and/or processing of UR reporting.
1.11 Evaluate processes, analyze gaps and escalate findings to Director to collaborate on a resolution.
1.12 Communicate with internal and external staff, members, providers and Health Plans regarding nature of UR cases and referrals, status updates including prompt response to inquiries.
1.13 Assist with health plan audit preparation, review and compiling of all requested files/documents.
1.14 Timely submission of all auditing documents and evidence to appropriate Health Plans by specified deadlines.
1.15 Communication with management team of audit related deadlines.
1.16 Organization and maintenance of all UR Health Plan written letter templates.
1.17 Ability to work in a team environment and collaborate with internal and external professionals and others.
1.18 Capable of learning fundamental departmental roles and processes with comprehension. Capable of performing non- clinical UR roles with accuracy and fluency.
1.19 Assist the UR Director in development of staff evaluations
1.20 Must be well organized of assigned duties, deadlines and prioritize based on urgency. Communicate potential delay in meeting deadlines with Director.
1.21 Demonstrate Microsoft Office (Word, Excel, Outlook) skills.
1.22 Adaptable to regulation and necessary departmental procedure changes that affect UR case and authorization processes.
1.23 Compliance with HIPAA regulations and maintenance of patient confidentiality.
1.24 Cultural and Linguistics training required annually.
1.25 Other duties as assigned.
Requirements:
8.1High school diploma or GED certification, required.
8.2 Bachelor's degree in business administration, or closely related field; or equivalent technical training/experience; or equivalent combination of education and experience.
8.3 Two years Managed Care Organization experience highly desired. 8.4 One year experience in a lead or supervisory role, required.
8.5 Experience in an auditing and/or analytical role.
8.6 Excellent written and oral communication skills.
8. 7 Familiar with CPT, HCPCs, and ICD-10 coding highly desirable 8.8 Familiar with medical terminology.
8.9 Proficient in Microsoft office (Word, Excel, Outlook).
The pay range for this position at commencement of employment is expected to be between $25.39 and $34.85 however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience. The total compensation package for this position may also include other elements, including a sign-on bonus, restricted stock units, and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
Compensation: $25.39 and $34.85