Humana

About Humana

 

Job Category:

Integrated Care & Care Operations - Care Management

Country:

United States

Postal Code:

33427

Approximate Salary:

Not Specified

Position Type:

Full Time

Supervisor, Case Management Support - Boca Raton, FL

Humana - Boca Raton, Florida

Posted: 11/17/2018

Description

The 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.

Responsibilities

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.

               

Required Qualifications

  • 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.

Preferred Qualifications

  • 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.

Additional Information

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 Hours

40

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