Senior Utilization Manager

2 weeks ago


Albany, New York, United States TenderHeart Health Outcomes Full time
Job Overview

Tenderheart Health Outcomes stands as the premier provider of Incontinence Management Services across the nation. Our mission is to deliver high-quality products and services that empower individuals to manage their incontinence effectively at home, while simultaneously generating healthcare savings within various managed care sectors.

Through our innovative value-based payment model, we collaborate with five national Managed Care Organizations to enhance healthcare savings and elevate patient outcomes. Our service delivery is underpinned by a comprehensive patient and caregiver coaching program, ensuring the provision of superior products. This robust support framework leads to optimal product utilization and a reduction in emergency room visits and hospital admissions.

Tenderheart employs a case rate approach that encompasses the at-risk population requiring incontinence support. We meticulously track product utilization costs, emergency room visits, and hospital admissions related to adverse conditions stemming from incontinence. Our secure data network facilitates seamless information sharing with Managed Care Organizations, overcoming data barriers through our proprietary portal system accessible to MCOs. The success of our value-based arrangements is attributed to our service delivery model, which focuses on member support volume and outcomes rather than the traditional unit cost associated with Fee for Service arrangements.

Position Summary:
We are currently in search of a Senior Utilization Manager to oversee essential daily operations. This role is pivotal in ensuring operational efficiency and staff productivity.

  • Key Responsibilities:
    Provide leadership and direction for daily operations.
  • Drive operational initiatives.
  • Ensure smooth functioning of all processes.
  • Motivate staff to achieve productivity targets.
  • Deliver weekly updates to management.
  • Maintain compliance with licensing, insurance, and office standards.
  • Engage employees monthly.
  • Manage a monthly caseload, making outbound calls or receiving inbound calls from patients and service coordinators to assess service needs and updates.
  • Communicate with patients to evaluate their monthly service requirements.
  • Address service-related complaints, referring issues to designated departments for resolution.
  • Participate in both traditional and e-learning training programs.
  • Perform additional duties as assigned.
  • Ensure adherence to company policies and procedures.
  • Collaborate effectively with colleagues, managers, and various departments.

Qualifications:

  • Minimum of 1 year of experience in a medical office or healthcare setting (Required).
  • 1 year of experience in utilization review (Preferred).
  • Experience as a CNA, Medical Assistant, or Medical Technician (Preferred).
  • Customer service experience (Preferred).

Benefits:

  • 401(k) plan.
  • 401(k) matching.
  • Dental insurance.
  • Disability insurance.
  • Flexible spending account.
  • Health insurance.
  • Life insurance.
  • Paid time off.
  • Referral program.
  • Vision insurance.

Work Schedule:
Full-time position with an 8-hour shift, Monday to Friday.

Salary: Starting at $22.00 per hour, with an expected workload of 40 hours per week.

Our Commitment:
Tenderheart is dedicated to providing exceptional incontinence management services and products that enhance health outcomes and broaden access to care, enabling more patients to lead happier, more confident, and independent lives.

Core Values:
Integrity: We uphold honesty and trust in all our actions.
Compassion: We listen, care, and respond to the needs of others.
Innovation: We strive to create service enhancements that address healthcare challenges.
Equality: We value diversity and promote inclusivity in our workplace.



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