Manager I in Medicaid Medical Management overseeing non-clinical specialists ensuring compliance and service delivery. Responsible for training and managing a team to improve program efficiency.
Responsibilities
Responsible for supporting the Medicaid Medical Management team by managing and overseeing non-clinical medical management specialists to ensure utilization regulatory compliance and member service delivery
Oversees compliance with turnaround times, productivity metrics, reporting, and call times
Supervises approximately 20 non-clinical medical management specialists
Manages resource utilization to ensure appropriate delivery of care to members
Adequate coverage for all tasks and job responsibilities
Participates in cross-functional workgroups created to maintain and develop program
Evaluates current processes of Special Program's support functions; recommends changes for increased efficiencies and improved outcomes
Develops and conducts training programs for staff involved in the program
Extracts and manipulates analytical data to present findings to relevant markets and stakeholders
Hires, trains, coaches, counsels, and evaluates performance of direct reports
Requirements
Requires a BA/BS
minimum of 5 years experience in a related field
minimum of 1 year leadership/management experience
Utilization review/utilization management experience is a must
A current unrestricted RN license issued by the Commonwealth of Virginia is very strongly preferred
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