Vacancy caducado!
Support the Manager with the supervision and oversight of the intake team care specialists and its strategic goal of ensuring appropriate/timely access of member benefits and compliance with all internal call center service and quality goals. Support the problem solving, execution, and continuous process improvement of the non-clinical aspects of participants care. Ensure that the team is appropriately configuring information in the system to effectively execute member care plans, troubleshooting system issues, originating authorizations, preparing paperwork/documentation as necessary, service ordering, handling participant inquiries, and essentially executing all of the mechanics behind the scenes. Work with Care Specialists to ensure that all necessary information is referenced and verified in responding to provider inquiries and appropriate case creation/routing. Assist the Manager with the planning & oversight of the daily intake team operations; manage a structured high call-volume Call Center with increased demand for quick reaction and response in a demanding fast-paced environment; make rapid in-the-moment decisions to ensure goals are met on a daily basis in conjunction with Call Center Leadership across the Enterprise. Responsibilities: Supervise the non-clinical case specialist intake call center team, ensuring the timely and appropriate execution of daily call center volume/inventory. Ensure the implementation of departmental processes designed to manage the UM Intake call center, including compliance with all internal and external call center relates service levels and quality, as well as ensuring appropriate member/provider medical benefit access. Assist Manager with staff adherence 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. Coach and mentor to staff to ensure understanding of utilization management concepts and the effective application of the concepts in managing members health care needs. Assist with compliance with State, Federal and NCQA requirements related to utilization management case-set up activities. Maintain an environment of quality improvement through continuous evaluation of processes and policies. Identify and recommend new technologies and process efficiencies. Perform other tasks/duties as assigned or required. Qualifications: Associates degree, preferably in Healthcare, business or communications. 3 - 5 years related work experience. 3 - 5 years of customer service call center experience, preferably in a supervisory or managerial role. 3 - 5 years of managed care experience. Additional years of related work experience may be considered in lieu of educational requirements. Prior supervisory experience. Strong oral and written communication and interpersonal skills. Strong organizational skills. Additional Information
Requisition ID: 200X2 Equal Opportunity Employer-minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity
Vacancy caducado!