Our organization is about doctors working to improve healthcare by giving back and serving the communities where they practice. We seek a passionate Manager of Utilization Management to manage our UM team and to help patients live healthy and brighter lives. To successfully achieve our mission and vision as we operate in a dynamic health care environment, we expect our employees to embody and uphold our core values in work and interactions, both internal and external: be brave, be brilliant, be accountable, be inclusive, and be collaborative.
The Manager of Utilization Management will drive excellent provider service within the Utilization Management function by oversight and monitor of staff, workflow, job aids, coordination of care, policies and procedures, turn-around-time requirements, and day-to-day non-clinical UM operations. The position will ensure execution against phone and fax management service goals such as average speed of answer and turnaround times and will also oversee staff who support Utilization Management functions. This leader will be accountable for driving continuous improvement in quality performance and administrative cost efficiency of the function. This role will be active in the hiring and development of their team as well as structure and network of vendors. The Manager of UM will facilitate, participate, and conduct UM internal and external audits alongside with the Chief Nursing Officer. The Manager will also apply deep knowledge of regulatory requirements to ensure compliance of other non-clinical tasks completed by the team. The Manager will work closely with the Utilization Management, Care Management, Delegation oversight, Provider Call Center, and Network-facing leadership teams.
The Manager of Utilization Management job description is intended to point out major responsibilities within the role, but it is not limited to these items and projects assigned by the CNO and CEO:
· Ensure appropriate usage of resources to facilitate the UM process. Coordinate projections from workforce management and scheduling analysts with supervisors from the network teams to ensure high service and output
· Ensure compliance within applicable accreditation standards, federal and state requirements, and line of business service delivery guidelines, including education and training of staff for consistent compliance to guidelines
· Assist with the hiring, development, training, and evaluation of UM non-clinical staff including corrective actions and terminating as needed. Oversee performance of non-clinical staff vendors to ensure productivity and quality standards are consistently met
· Evaluate UM policies and procedures and recommend enhancements
· Assist with ensuring consistent data collection from UM non-clinical staff that is used to assist the company in achieving corporate goals to improve monitoring and reporting to meet external and regulatory requirements
· Identify opportunities for quality and process improvements necessary to facilitate department functions
· Educate staff as necessary to ensure consistent performance and adhere to standards
· Support coordination of programs through maintenance and oversight of cross-functional communication and referral procedures
· This position will manage a team of Non-Clinical Staff and will oversee network vendor resources.
· The majority of work responsibilities are performed remotely, carrying out detailed work sitting at a desk/table and working on the computer.
· Previous experience as a lead in a functional area or managing cross functional teams on large scale projects is required.
· Bachelor’s degree in Sales and Marketing, Business, Healthcare Administration, or related field (Master’s preferred)
· Three (3) or more years of utilization management/ healthcare operations/ quality improvement experience, in a managerial capacity is required.
· Working knowledge and understanding of basic utilization management and quality improvement concepts.
· Previous experience working with vendors and resources preferred.
· Prior experience with highly regulated environments including federal, state, and national accreditation standards preferred.
· Experience with problem management, change control and how to influence change without direct control within a decentralized business unit culture.
· Experience managing teams with high visibility across products/business capabilities with experience identifying and managing dependencies within and across teams preferred.
· Excellent writing skills, particularly in determination notification writing.
· Ability to develop strong cross-functional and collaborative relationships with internal and external partners, including the ability to work with a wide variety of people and personalities.
· Must be self-motivated, able to take initiative, and ability to thrive and drive results in a collaborative and some remote environment.
· Must possess strong organizational and prioritization skills and competence and capacity to handle multiple initiatives while managing conflicting priorities.
· Must possess strong interpersonal, communication and time/project management skills are essential.
· Experience in using the Microsoft Office Suite including Excel and Word as well as demonstrated ability to learn/adapt to other computer-based systems and tools.
For more information about Trivium, visit www.trivium.com Interested applicants may forward a résumé, cover letter and references to the attention of Ramya at firstname.lastname@example.org.
We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: poster_screen_reader_optimized.pdf