Healthcare Manager

3 days ago

Kansas City, Missouri, United States Elevance Health Full time
Job Title: Manager of Utilization Review

Job Summary:

Elevance Health is seeking a skilled Manager of Utilization Review to oversee a team of physical health practitioners responsible for coordinating member service, utilization, access, care management, and concurrent review to ensure cost-effective utilization of healthcare for one or more member product populations of varying medical complexity.

Key Responsibilities:

  • Manage and oversee a team responsible for case finding and coordinating cases involving comorbid conditions.
  • Coordinate service delivery, including member assessment of physical factors.
  • Partner with providers to establish short- and long-term goals that meet the member's needs, functional abilities, and referral sources requirements.
  • Identify members with potential for high-risk complications.
  • Review benefit systems and cost-benefit analysis.
  • Evaluate medical for cost containment.
  • Support program compliance and assist in identifying opportunities to improve customer service and quality outcomes.
  • Support quality initiatives and activities, including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting.
  • Hire, train, coach, counsel, and evaluate the performance of direct reports.

Requirements:

  • BA/BS and a minimum of 5 years of experience in healthcare management or any combination of education and experience that would provide an equivalent background.
  • Current active unrestricted compact RN, PA, LSW, LCSW, LPC, LMHC, or other accepted license (as allowed by applicable state laws) and any other state or federal requirements that may apply.

About Elevance Health:

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

Our Culture:

We are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes, and drive our shared success for our consumers, associates, communities, and business.

Benefits:

We offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short- and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.

Work Environment:

We operate in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

Equal Employment Opportunity:

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws.

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