UM Clinical Manager Outpatient Support - West Region in Cypress, CA at Beacon Health Options

Date Posted: 6/26/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic UM Manager of Clinical Outpatient Support to join our Utilization Management team in Cypress, CA! Under the supervision of the Director of Outpatient Services, the Manager of Clinical Support supervises all outpatient administrative staff and has direct oversight of all department administrative functions.  The Manager of Clinical Services works closely with the Director of Clinical Services and the AVP of Clinical Operations to ensure the service centers clinical processes and procedures are in alignment with client expectations, clinical corporate, regulations and accreditation standards.

Position Responsibilities:

  • Supervise day-to-day duties of department administrative staff.
  • Monitor individual staff and aggregate department performance to ensure all customer, accreditation and regulatory standards are met.
  • Interface with members, facilities, providers and their office staff to problem solve, answer questions and provide benefit information.
  • Responsible for hiring and training of new employees.
  • Responsible for employee evaluations, disciplinary procedures and terminations as indicated, in accordance with company policies.
  • Remain aware of payer contract requirements and company policies and procedures and updates administrative staff.
  • Conduct monthly staff meetings in coordination with department director and leads.
  • Provide ongoing training and training materials for administrative staff.
  • Complete quarterly audits for all administrative staff.
  • Delegate and oversee additional responsibilities of Office Assistant staff.
  • Other specific duties and projects assigned by the Director of Outpatient Services.
  • Responsible for staff work schedules, including lunches and breaks and paid time off.
  • Actively monitor access and member follow-up queue to ensure timeliness standards are met.
  • Responsible for evaluating, developing and implementing workflows for various job descriptions within the department.
  • Responsible for completing and reporting monthly performance data on urgent and routine access.
  • Comply with all Beacon policy guidelines, external regulatory requirements and URAC/NCQA accreditation standards.
  • Attend and participate in CMC meetings and other meetings as assigned by Director of Outpatient Services.
  • Monitor staffs compliance with mandatory trainings.
  • Assign screenings/registrations to be entered into Raintree and Flexcare.
  • Monitor completion of denial and authorization letters.
  • Monitor completion of language interpreter requests for services.
  • Research eligibility and benefit issues and refer to department director as needed.
  • Adheres to all Beacon policies and procedures and standards of operations.
  • Completes all required and assigned trainings.
  • Performs annual staff reviews and establish individual/team goals for development.
  • Motivates team members to reach department goals and objectives.
  • Attends all mandatory company or department meetings.
  • Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.
  • Acts as a mentor to team members by leading by example and guiding with a sense of integrity and team work.
  • Meets regularly with team members for one on ones and staff meetings.
  • Identifies opportunities for staff improvement, high performing team members, and training needs of team members.
  • Partners with management to identify areas of opportunity within department and makes improvements on processes, culture, or work environment.
  • Acts as a liaison between staff, management, and other functional departments for consistent improvements of functions and work flow.
  • Identify misconduct and finds resolution and escalate to Human Resources.
  • Performs special projects and other duties as assigned and required.

Position Requirements:

  • Education: Associates Degree in healthcare related field required
  • Relevant Work Experience: 2 years’ experience as a supervisor in healthcare related field, or 3 years of lead customer service experience with staff oversight and management responsibilities including but not limited to hiring, performance management, and training required

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled