8 days old

Manager Utilization Management WellMed San Antonio TX

San Antonio, TX 78205
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Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm) 
The Manager of Utilization Management Operations is responsible for driving cost effective, quality of care services for members through daily coordination among medical directors, UM staff, the provider network and various other departments. This position is also responsible for overseeing all compliance functions, the denial and appeal process and for providing administrative and leadership support to staff in accordance with policies and procedures.
Primary Responsibilities:
  • Performs daily oversight for the UM Supervisors
  • Manages the compliance for UM phone queue to meet established performance metrics
  • Oversees medical claim review inventory and regulatory timeframes
  • Manages all aspects of the UM claim review inventory and service timeframes.
  • Manages all aspects of the Inpatient Census and CM support inventory and service timeframes
  • Manages all aspects of the denial and UM correspondence inventory and service timeframes
  • Conducts routine audits on UM reviews to ensure adherence to CMS regulations
  • Produces daily, weekly and monthly operational reports for senior leaders
  • Organizes and presents at staff meetings and provider education sessions on utilization management processes
  • Applies employee performance management techniques through job-related coaching, training and development activities
  • Performs all other related duties as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Posted: 2020-03-20 Expires: 2020-04-20

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Manager Utilization Management WellMed San Antonio TX

UnitedHealth Group
San Antonio, TX 78205

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