Utilization Management Manager - Physical Health (Hybrid/Remote)
Partners Health Management
Remote
utilization
utilization management
management
manager
physical health
health
remote
management
team
training
operational
supervision
leadership
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November 18, 2022
Partners Health Management
Kannapolis, North Carolina
FULL_TIME
Competitive Compensation & Benefits Package!
Position eligible for –
Annual incentive bonus plan
Medical, dental, and vision insurance with low deductible/low cost health plan
Generous vacation and sick time accrual
12 paid holidays
State Retirement (pension plan)
401(k) Plan with employer match
Company paid life and disability insurance
Wellness Programs
See attachment for additional details.
Office Location: Flexible for any of our office locations; Hybrid or Remote Option Available
Projected Hiring Range: Depending on Experience
Closing Date: Open Until Filled
Primary Purpose of Position:
The UM Manager is responsible for proactive and focused leadership, clinical, supervisory and operational oversight of UM activities and responsibilities. This position requires a proactive and focused risk management approach to leadership and oversight. The Manager is responsible for consistent implementation of systems and operational guidelines which support quality and clinically sound utilization management. This role requires strong and positive leadership skills, strong clinical skills, a collaborative approach to problem-solving and a strong understanding of quality improvement techniques and processes.
Role and Responsibilities:
The UM Manager is responsible for (though not limited to):
Administrative/Operational Leadership
Provides leadership, in collaboration with other managers/leaders, to promote strong cohesiveness among all agency employees regardless of department, role or office location…promotes one vision, one voice
Works closely with other UM Managers to ensure consistent workflows and good communication between teams
Ensures strong collaborative problem-solving with other departments
Ensures consistent implementation of established work processes, with focused effort on identifying and remediating potential issues as proactively as possible
Assists in implementation and management of clinical and administrative initiatives
Actively collaborates with other agencies, organizations, and both formal and informal community resources to promote quality outcomes for our consumers
Monitors trends in individual and team performance through review of QI data, use of available reports, direct observation and monitoring of work, etc.
Monitors high risk situations and intervenes quickly to prevent or quickly address concerns/issues
Identifies training/support needs for team members and ensures that needed training/support is received
Promotes customer/community stakeholder satisfaction through ongoing communication, refinement of work processes as needed, and timely follow-up on any concerns/issues
Ensures that opportunities for increased efficiency are identified and acted on
Promotes a positive work environment by exemplifying a positive, solution focused, can-do attitude and fostering the same in all team members
Continuous Quality Improvement
Ensures active QI process which focuses on proactive management of risks and quality
Ensures that QI/performance data is maintained, reviewed and shared with Supervisors, facilitating discussion of accomplishments and opportunities for quality enhancement
Ensures that QI efforts are well documented at all levels and that all identified issues or opportunities for quality enhancement/increased efficiency are followed up on in a timely manner.
Ensures timely submission of accurate QI data
Proactively monitors performance of direct reports and their team(s) through observation and review of service documentation, identifying and remediating identified issues in a timely manner
Utilizes and models person centered planning methods/strategies as appropriate during supervision/training, including use of person centered thinking tools
Promotes the ongoing assessment of goals and planning which supports attainment of personal outcomes
Assists in development/revision of clinical and operational systems and guidelines to implement and reflect the agency’s focus on operational excellence, outcomes-based service philosophy as well as service system regulations and standards
Ensures that all grievances and provider concerns are reported and/or resolved in a timely manner
Participates in assigned committees/task forces to promote best practices and to ensure open communication
Participates in internal/external reviews of services and ensures follow-up for any unsatisfactory areas noted.
Supervision
Provides direct supervision of Utilization Management staff as indicated
Ensures that all team members receive strategic coaching/training/supervision to develop and maintain competency
Ensures that the team has needed knowledge/skill to actively support UM activities including addressing issues/concerns and to train UM duties
Monitors the work of employees supervised through regular direct observation/review of job performance and provides needed direction/guidance, including timely supervisory counseling and/or disciplinary action when needed
Reviews/approves all requested expenditures (e.g. travel, training, purchases) to ensure efficient use of resources
Objectively and thoroughly completes all employee performance reviews (probationary and annual) by due date
Ensures that all team members receive ongoing trainings of changes in state, agency, or departmental regulations, policies, procedures, and operational guidelines
Ensures that meetings/supervision sessions are documented
Follows, and ensures that team members supervised follow established protocols for documentation of supervision/training, recommendation of regular status at the end of the probationary period, and other personnel duties
Ensures proactive communication with Assistant Director and Director of Utilization Management
Ensures effective communication between contracted staff and Partners staff
Knowledge, Skills and Abilities:
Comprehensive knowledge of the assessment and treatment of Medicaid population needs.
Comprehensive knowledge of the Medicaid PH service array provided through the network of providers
Knowledge of the unique challenges faced by the MH/SU/IDD population, treatment interventions and evidence based practices for these populations with co-occurring medical disorders
Knowledge of Tailored Plan, Public Health, Clinical Policy and clinical guidelines as they relate to authorization of services
Strong critical thinking skills
Working knowledge of laws, regulations, and program practices/requirements impacting members and families
Ability to establish and maintain a positive, productive and high performing work environment
Ability to coordinate, train and oversee duties of others to ensure high quality services
Knowledge of and ability to facilitate a continuous quality improvement process
Knowledge of community resources and commitment to promote use of those resources
Ability to provide effective and clinically sound consultation/education/training to others
Ability to use good judgment and make data-based decisions
Ability to establish and maintain positive and effective working relationships with others both within the agency and community
Ability to express directions, comments and opinions clearly and concisely in oral and/or written form.
Ability to understand and interpret complicated written material and verbal presentations.
Skill and ability to demonstrate diplomacy as well as the ability to handle stressful situations
Ability to demonstrate initiative and effective, solution-focused, problem-solving skills
Detail-oriented, able to organize multiple tasks and priorities and to effectively manage projects from start to finish
Ability to make prompt independent decisions based upon relevant facts, to establish rapport and maintain effective working relationships
Ability to lead by example
Excellent computer skills (WORD, Excel, Microsoft Outlook, Internet)
Ability to assess personal strengths/needs and identify needed training to promote own professional development
Education/Experience Required:
Licensed to practice as a Registered Nurse in North Carolina, four (4) years of professional experience as an RN, and three (3) years of supervisory experience. Experience in public health or healthcare administration.
Education/Experience Preferred:
Experience in Utilization Management, with quality improvement processes, person centered practices and data management. Experience working with individuals with behavioral health disorders or Individuals with Intellectual/Developmental Disorders.
Licensure/Certification Requirements:
Licensed to practice as a Registered Nurse in North Carolina by the N. C. Board of Nursing. Employee is responsible for complying with respective licensure board’s continuing education/training requirements to maintain an active license.
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