Utilization Management Support Supervisor

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Provides daily oversight of the Utilization Management Support Services unit. Responsibilities include, but are not
limited to staffing, call monitoring, quality assurance/process monitoring, customer problem resolution, enrollment, and
provider relations. Works with the management team of Coordinated Care in creation and implementation of shared
projects and workflows to ensure compliance with NYS DOH and CMS regulations. Responsible for oversight of service
authorizations and admission/discharge documentation processing. Assists staff in managing caseloads and provides
ongoing monitoring of staff productivity, attendance, and quality of work.

• Baccalaureate Degree preferred, 3 to 4 years' experience in healthcare
• 4-5 years' experience in business, human services, or a health-related field
• 2 years supervisory experience preferred.
• 2-3 years' experience in provider relations and/or member services in managed
  care.
• Prior experience with Medicaid managed care.
• Knowledge of the service delivery needs of the elderly, chronically ill or
  disabled.
• Working knowledge of Windows, Word, Excel and care management/utilization
  management software systems
• Strong interpersonal and organizational skills
• Excellent written and verbal communication skills
• Excellent analytic skills, interpretation of data
• Possess strong critical thinking skills and knowledge of Medicare and Medicaid
  regulations.
• Work effectively within interdisciplinary team environment
  Ability to set priorities and to handle multiple assignments.
• Working knowledge of audit techniques and methodologies
• Working knowledge of State and Federal regulations
• Possess good judgment and sense of urgency
• Ability to secure relevant information to identify potential problems, escalate, and
  make recommendations for appropriate solutions