Supervisor, UM Delegation Oversight
6 days ago
Summary
The UMDO Supervisor’s primary responsibility is to oversee and strategize the day-to-day operations of UM Compliance and NOA Operations. The Supervisor will report directly to the Sr. Supervisor of UM Delegation Oversight.
Duties and Responsibilities
· Oversight of the effective, timely, and compliant support for all UM audits and requests for information from upstream business partners and ensure consistent accuracy, timeliness, and compliant submissions
· Accountable for the quality and continued improvement of NOA operations
· Oversee, monitor, and evaluate monthly NOA operation production and adjust workflows, as needed
· Oversee and monitor the health plan letter template implementation process
· Monitor the data integrity and timeliness of all UM audit requests (pre- and post-audits)
· Develop and maintain monitoring/Quality Assurance (QA) methods and tools to self-identify and correct potential
· Support the UM team in developing root cause analysis and potential solutions to corrective action plans (CAPs) requested from auditors/clients
· Maintain annual UM audit and committee schedule to ensure readiness
· Create and maintain P&Ps that document UM methods, regulations, and protocols
· Maintains appropriate audit documentation/artifacts for all UM audit activities
· Serve as the UM representative in key Compliance meetings (i.e., weekly Compliance Huddles) presenting UM performance results, as necessary to UM, Compliance, and Executive leadership
· Responsible for continuous oversight of the training of staff on systems and departmental workflows
· Collaborate with UM leadership in developing necessary workflows and SOPs for improvement opportunities
· Prepare corrective action plans and develop SMART goals on identified deficiencies to mitigate potential risk
· Accountable for staffing ratio
· Oversee the team member’s user guide, training assessment, and implementation
· Counsel team members appropriately and conduct formal disciplinary action, as needed
· Initiate and follow through with special projects
· Effectively communicate updates, trends, opportunities, and/or progress with their direct supervisor
· Plan and conduct monthly team huddles, events, and team activities
· Attend UM and Compliance meetings as required
· Perform other duties as assigned
Minimum Job Requirements
· BS/BA required, Master's Degree or Clinical Degree preferred
· 3+ years’ experience working in UM operations with a focus on compliance/operations
· Strong familiarity with UM, NCQA Standards, DMHC, DHCS, and CMS regulatory requirements
· Proficiency in Microsoft Office (Word, Excel, PowerPoint, Visio, OneNote)
· Ability to navigate EZ-CAP, Tableau, and Smartsheet
Skill and Abilities
· Excellent written and verbal communication skills
· Ability to communicate with all levels of management and influence employees through strong communication and presentation skills
· Excellent organizational skills with the ability to balance several priorities
· Strong interpersonal skills
· Ability to make sound judgments and act professionally under pressure
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