Supervisor Long Term Services
2 weeks ago
**Supervisor Long Term Services & Support Utilization Management Non Clinical**
Location: Remote, United States
Primary Job Function: Medical Management
ID**: 34483
Your career starts now. We are looking for the next generation of health care leaders.
At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to connect with you. Headquartered in
Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
**Responsibilities:**
Under the supervision of the LTSS Manager for Utilization Management, this position provides daily oversight of LTSS Review UM Technicians and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing technical and operational support and direction and organizing and monitoring all LTSS services. Responsible for direct supervisory oversight and day-to-day activities of the LTSS UM Technicians or other non-exempt or non-clinical staff to ensure all processes are completed and deadlines are met. Maintains knowledge of phone and service level requirements for compliance with ACFC policies and procedures as well as Medicaid and CHC requirements.
+ Oversees the day-to-day operations of the LTSS Review UM Technicians, including Quality Assurance of OLTL-approved templates, notification requirements to participants and providers to maintain UM compliance under the CHC Final Agreement
+ Works with Providers to correct authorization to claim issues, monitors authorization reports and dashboards, and monitors compliance for authorizations for the plan
+ Performs and remains knowledgeable in all workflow and timeliness requirements for all areas of Utilization Management
+ Serves as a subject matter expert for LTSS training for internal care teams and external audiences.
+ Assists with the daily operations of non-licensed professionals in the LTSS Review UM Department.
+ Monitors staff work assignments and makes appropriate adjustments based on staffing levels, staff experience, and number/request types of authorizations/appeals received.
+ Assist the LTSS UM Manager in providing oversight for operational reporting compliance
+ Provide coaching and counseling to improve the productivity of staff members within the LTSS Review UM Department.
+ Works collaboratively and supports the Service Coordination department of LTSS with other clinical and social services across the continuum of care, striving to enhance the quality of Participant care and services.
+ Assesses candidates and ensures optimal qualifications are met as a department's interview team member.
+ Plans, develops, and supports or conducts orientations and training programs and creates educational material for staff members to improve skills, aid in professional growth and development, and ensure staff's expertise.
+ Reviews quality audits and shares audit results promptly with associates, providing necessary education and counseling to improve performance.
+ Collaborates with the Manager and identified leadership to develop and implement performance measures and monitor associates placed on performance improvement plans.
+ Responsible for writing and finalizing performance reviews for direct reports with Manager input.
+ Participates in process reviews and developing new and revised work processes, policies, and procedures relating to LTSS Utilization Review.
+ Accurately answers questions regarding CHC benefits for members and providers.
+ Maintains awareness and complies with Plan CHC authorization timeliness standards based on DHS/NCQA requirements
+ Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity.
+ Establishes and maintains positive communication and professional demeanor with internal and external customers, providers, and participants.
+ Maintains operational processes, policies, procedures, and reports to support LTSS care delivery
+ Stays current with ACFC policies and procedures, Medicaid, and CHC requirements
**Education/Experience:**
+ Bachelor's Degree.
+ 3 to 5 years experience supervising in a contact center environment with processes to provide accountability in a high volume call environment, preferred working in a health care/managed care environment and supervisory experience preferred.
+ Excellent communication skills, oral and written; excellent listening skills.
+ Solid knowledge of contact center processes to provide accountability in high volume call environment, managing audits/reports
+ Strong knowledge base of health care resources, ideally with managed care experience.
+ Demonstrated ability to promote excellent customer service skills.
+ Skill in working with diverse teams and collaborating with various disciplines within a market or Plan is highly desirable.
**Diversity, Equity, and Inclusion**
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
**Our Comprehensive Benefits Package**
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
EOE Minorities/Females/Protected Veterans/Disabled
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