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Supervisor, Utilization Management Operations

Company: Lumeris
Location: Saint Louis
Posted on: November 11, 2019

Job Description:

In order to apply for a position at Lumeris, you must create an account using your email address and a password of your choosing. This account will allow you to receive notifications each step of the way through the job application process. With these updates, youll never have to wonder where you are in the process. Additionally, we can easily send pertinent documents to you for your review. Once you create the account, you may apply to any position you feel is a good fit without having to re-enter information. Thank you for your interest in Lumeris. Position: Supervisor, Utilization Management Operations Position Summary: This position manages the non-clinical Utilization Management (UM) staff in the Medical Management Department, which includes Medical Service Representatives (MSR) and UM administrative assistants. Non-clinical UM staff help administer the following in conjunction with clinical staff: PCP referral requests, coverage requests for health care services requiring prior authorization or notification, coordination with hospitals and PCP offices on inpatient notifications, Medicare Part C reporting, monitoring programs for regulatory compliance, pended medical claims, and health risk assessments. Job Description: Role and Responsibilities - Monitor all staff needs, including training requirements, quality and production. - Work with Director of Learning and Development to create department production development plan. - Review all departmental processes and identify efficiencies, gaps, and process improvements. Develop plan to improve efficiencies, bridge gaps, and improve processes. Create SOPs to support all processes. - Review and manage departmental budget. - Allocate expenses for all invoicing requirements to support the department. - Responsible for day to day operations and supervision of the UM Non clinical team in accordance with administrative and departmental policies and procedures - Plan and lead quarterly staff meetings to review previous quarters production, quality, FAQs, and efficiencies. - Assist with CMS audits and client interactions - Provide counsel on performance issues Experience, Qualifications, and Education - Associate's degree or equivalent years of related experience - 3+ years of supervisory experience - Experience in Utilization Management in a Medicare managed care environment preferred - Excellent interpersonal, oral and written communication - Strong problem solving and issue resolution skills - Ability to effectively present information to the team, cross functioning departments, clients and upper management - Ability to lead/manage others, successful management experience in the Healthcare field, prefer Medicare experience especially with Federal Regulations - Ability to work independently, handle multiple assignments, establish priorities, and demonstrate high level time management skills - Proficiency in Microsoft Office including Outlook, Work, Excel, Notebook and PowerPoint. - Knowledge with Facets, SharePoint and Knowledge Lake a plus - Ability to multi-task and self-motivate - Knowledge of medical terminology Lumeris is an EEO/AA employer M/F/V/D. Location: St. Louis, MO Time Type: Full time

Keywords: Lumeris, St. Louis , Supervisor, Utilization Management Operations, Executive , Saint Louis, Missouri

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