Supervisor Ltss Utilization Management Non-Clinical

Responsibilities:

Under the supervision of the LTSS Manager for Utilization Management, this position is responsible for providing daily oversight of LTSS Review UM Technicians and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing technical and operational support and direction, including organization and monitoring of all LTSS services. Responsible for direct supervisory oversight and day-to-day activities of the LTSS UM Technicians or other non-exempt or non-clinical staff to ensure all processes are completed and deadlines are met. Maintains knowledge of phone and service level requirements for compliance with ACFC policies and procedures, Medicaid and CHC requirements.

• Reviews quality audits and shares audit results in a timely manner with associates, providing necessary education and counseling to improve performance.
• Assists with the daily operations of non-licensed professionals in the LTSS Review UM Department.
• Stays current with ACFC policies and procedures, Medicaid and CHC requirements
• Accurately answers questions regarding CHC benefits for members and providers.
• Works collaboratively and supports the Service Coordination department of LTSS with other clinical and social services across the continuum of care striving to enhance the quality of Participant care and services.
• Maintains operational processes, policies, procedures and reports to support LTSS care delivery
• Assist the LTSS UM Manager in providing oversight for operational reporting compliance
• Participates in process reviews and the development of new and/or revised work processes, policies and procedures relating to LTSS Utilization Review.
• Performs and remains knowledgeable in all workflow and timeliness requirements for all areas in Utilization Management
• Maintains awareness and complies with Plan CHC authorization timeliness standards based on DHS/NCQA requirements
• Responsible for writing and finalizing performance reviews for direct reports with Manager input.
• Oversees the day to day operations of the LTSS Review UM Technicians including Quality Assurance of OLTL approved templates, notification requirements to participant and providers to maintain UM compliance under the CHC Final Agreement
• Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity.
• Monitors staff work assignments and makes appropriate adjustments based on staffing levels, staff experience, and number/request types of authorizations/appeals received.
• Plans, develops and supports or conducts orientations, training programs and creates educational material for staff members to improve skills, aid in professional growth and development and to ensure staff’s expertise.
• Assesses candidates and ensures that optimal qualifications are met as a member of the department’s interview team.
• Establishes and maintains positive communication and professional demeanor with internal and external customers, providers and participants at all times.
• Works with Providers to correct authorization to claim issues, monitors authorization reports and dashboards and monitors compliance for authorizations for the plan
• Provides coaching and counseling to improve productivity of staff members within the LTSS Review UM Department.
• Serves as a subject matter expert for LTSS training for internal care teams and external audiences.
• Works collaboratively with the Manager and identified leadership to develop and implement performance measures, and monitors associates placed on performance improvement plans.

Education/Experience:

• Solid knowledge of contact center processes to provide accountability in high volume call environment, managing audits/reports
• Skill in working with diverse teams and ability to collaborate with various disciplines within a market or Plan is highly desirable.
• Strong knowledge base of health care resources, ideally with managed care experience.
• Excellent communication skills, oral written; excellent listening skills.
• Bachelor’s Degree.
• Demonstrated ability to promote excellent customer service skills.
• Associate’s Degree.
• 3-5 years experience supervising in contact center environment with processes to provide accountability in high volume call environment, preferred working in a health care/managed care environment, Supervisory experience preferred.