DescriptionThe Supervisor, Care Management Support contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Supervisor, Care Management Support works within thorough, prescribed guidelines and procedures; uses independent judgment requiring analysis of variable factors to solve basic problems; collaborates with management and top professionals/specialists in selection of methods, techniques, and analytical approach.
The Supervisor, Care Management Support contributes to administration of care management.
The Supervisor, Care Management Support;
- Manages the Care Management Support team.
- Develop and update authorization processes and facilitate team training.
- Interface with the Utilization Management team to ensure authorizations are processed as per clinical guidelines.
- Ensure authorizations are processed within timeframe defined by contract and operational leadership.
- Monitor Care Management Support Assistant's authorization queues in CGX.
- Monitor daily pending authorization reports and identify trends and adjust associate assignment as needed.
- Reviews daily Care Management Support Assistants production and initiate audits of authorizations and identify training needs.
- Identify and track authorization processing issues and identify additional training opportunities for the clinical team.
- Propose system changes to optimize authorization processing.
- Primary for the resolution of provider claim inquiries due to authorizations issues.
- Liaison with Provider Relations and Claims to resolve provider claim issues
- Monitor CCP queues.
- Review, distribute and track authorization rework projects.
- Track special authorization claim review projects as forwarded by Provider Relations, Customer Service and Claims.
- Receive notice from Clinical Critical Inquiry Unit of AHCA complaints and address any issue from the Clinical Inquiry Unit.
- Associates Degree.
- 2- 4 years of experience in a lead/supervisory role.
- Minimum of 2 years of Medicare Medicaid claims processing, claims review or claims adjudication experiences.
- Intermediate to advance skills in Microsoft Word, Excel, PowerPoint and Outlook.
- Demonstrates independent decision making for complex analytical issues.
- Ability to manage multiple or competing priorities.
- Strong communication skills.
- Strong organizational skills.
- Must be very detail oriented.
- Must be customer focused.
- Experience with CGX, CAS, PMDM, PAAG, SL, CCP, CRM, CI, FLMMIS
- Bachelors or a Masters Degree..
- 5 or more years of leadership experiences.
- Microsoft experience with Access.
- Technical experience using data analysis.
Experience with business strategic outcomes.
As part of our hiring process, we will be using an exciting interviewing technology provided by Montage, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours40