1 Lead, UM Delegation Oversight Job in Woodland, CA
MEDPOINT MANAGEMENT is Hiring a Lead, UM Delegation Oversight Near Woodland, CA
Summary
Duties and Responsibilities:
- Routinely prioritize, schedule, and communicate assignments with team members
- Oversee the communication between UM, Compliance, and other departments
- Monitor the UM audit requests to ensure consistent accuracy, timeliness, and compliant submissions
- Monitor the data integrity and timeliness of all UM audit requests (pre- and post-audits)
- Support positive collaborative relationships with MPM functional areas (i.e., Compliance, PNO, Claims, etc.) to develop key performance indicators (KPIs) and efficient methods/tools that support accurate and timely UM operational areas and audit submissions
- Support the UM team in developing root cause analysis and potential solutions to corrective action plans (CAPs) requested from auditors/clients
- Maintain monitoring/Quality Assurance (QA) methods and tools to self-identify and correct potential non-compliant UM information (e.g., universes, sampled case files, CAPs)
- Assist in special projects and compliance audit inquiries and research
- Oversee the annual UM audit schedules to ensure audit readiness, including the need to renegotiate audit timing, if warranted
- Create and maintain P&Ps that document UM methods and protocols
- Maintains appropriate audit documentation/artifacts for all UM audit activities
- Responsible for continuous coaching and training team members
- Perform other related duties as assigned
- Attend UM and Compliance meetings as required
Minimum Job Requirements:
- High School Diploma (Bachelor’s degree preferred)
- 3 years’ experience working in UM operations with a focus on compliance/operations
- Strong familiarity with UM, NCQA Standards, DMHC, DHCS, and CMS regulatory requirements
- Proficiency in Microsoft Office (Word, Excel, PowerPoint, Visio, OneNote)
- Ability to navigate EZ-CAP, Tableau, and Smartsheet
Skills and Abilities Required:
- Excellent written and verbal communication skills
- Ability to communicate with all levels of management and influence employees through strong communication and presentation skills
- Excellent organizational skills with the ability to balance several priorities
- Strong interpersonal skills
- Ability to make sound judgments and act professionally under pressure
Salary Range:
- $68k-$70k annual
Job Summary
Full Time
$78k-95k (estimate)
05/14/2024
07/12/2024
medpointmanagement.com
WOODLAND HILLS, CA
25 - 50
1988
SHELDON LEWENFUFF PREIDENT
$10M - $50M
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About MEDPOINT MANAGEMENT
MedPoint Management provides IPA management, development and consulting services as well as comprehensive claims processing, medical affairs and financial operations. Clients receive the services of a large medical system in a smaller, more personal setting. MedPOINT Management, Inc. (MPM) provides all aspects of managed care management services to Independent Practice Associations (IPAs) and hospital clients. Our customized management approach meets the unique needs of each of our clients which allows us to successfully manage smaller groups comprised of single physician practices along with ...large groups of FQHC clinics and all practice models in between. Our experienced and knowledgeable staff provides a consistently high level of healthcare management services and strategies. Innovation and commitment to high quality, cost-effective care contribute to the overall satisfaction of our clients and members. Founded in 1987, MedPOINT currently represents a client base of over 4,000 contracted providers throughout California. Our managed IPAs are responsible for coordinating care for over 950,000 members in multiple contracted health plans. The contracts represent various payer mixes including Commercial HMO/PPO, Medi-Cal, Covered California (Exchange), Medicare Advantage and Medi-Medi including CalMedi Connect product lines. Understanding the power of information, MPM has made a significant investment in sophisticated IT systems enabling our management, clinical and administrative staff to efficiently work to coordinate high quality, cost effective, integrated care. The ability to readily track and trend utilization and quality metrics has been a vital component in improving overall health management, impacting the delivery of chronic and episodic care, yielding favorable health outcomes, and assisting our provider networks to meet or exceed health plan benchmarks for HEDIS, STARs and P4P programs. MedPOINTs full range of services are consistently delivered with the same high quality standards that has built our reputation. Flexibility, innovation and an openness to change are what the future demands of us as the nation moves into a new era of Health Care reform. The services MPM is delivering today will continue to embrace these notions to add value to our current and future client base.
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