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Supv - Medical Management

GEHA is a leader in health services for federal employees and related customers, serving our chosen markets with low-cost offerings and best-in-class customer care, sustained by a nimble and efficient organization.

An Executive Order was released stating that federal contractors must require COVID-19 vaccinations for all US employees. As a company that works on federal contracts, we have a legal requirement to comply with the executive order, if it is enforced.

Responsible for supervising the daily operations of the Medical Management Department clinical programs and processes. Serves as the primary contact for staff, assigned to internal and external programs, and escalated issues. Assists Manager with developing utilization policies and procedures. Monitors internal and external policies and workflow for compliance in regards to departmental goals. Provides support and supervision to internal clinical (licensed) and clinical support (non-licensed) department staff. Works under the direct supervision of the Medical Management Manager.

Please note that the salary information is a general guideline only. GEHA considers factors such as (but not limited to) scope and responsibilities of the position, candidate's work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer.

The annual base salary range for this position is $68,914 - $96,486 USD.
SKILLS

Duties and Responsibilities

  • Supervises the Medical Management clinical (licensed) and clinical support (non-licensed) staff, as assigned. Serves as a resource for all team staff regarding program workflows, clinical documentation, claims processing system issues, and work distribution.

  • Coordinates department workload and identifies staffing needs or other resources to meet quality, quantity and departmental goals. Communicates changes in departmental processes and procedures to staff when necessary.

  • Serves as primary contact for staff, assigned internal and external programs and escalated care management issues. Tracks and trends performance of assigned staff, using department metrics. Assists clinical and clinical support team with complex or escalated cases and notifies department Manager as appropriate.

  • Recommends promotion, termination, hiring or reassignment of subordinates including scheduling and conducting informal and formal employee performance reviews. Maintains attendance records and approves leave requests.

  • Reviews performance issues with Manager and makes recommendation regarding level of discipline. Develops communication form, action plan, and delivers disciplinary action after reviewing with the Manager.

  • Communicates outside the department to other Supervisors, Assistant Supervisors, and leads regarding specific member claim issues. Identifies potential process improvement opportunities across departments and makes recommendations to Managers as appropriate.

  • Audits staff processes and reviews cases with staff to assess compliance with established clinical and clinical support guidelines, workflows, and adherence to benefits structure and member progress towards goals. Consults with the Manager regarding complex and/or high profile cases.

  • Produces routine and ad hoc reports to track staff productivity and program measures of success. Reviews reports, identifies issues and trends, and makes recommendations to Manager.

  • Assists with development of training materials. Identifies educational opportunities for the staff. Informs and collaborates with department educator to provide on-site educational opportunities.

  • Responsible for the development, implementation, and maintenance of policies and procedures. Collaborates with Manager in creating, updating, and revising policies and workflows.

  • Coordinates department project planning to accommodate the company's annual business needs. Works with management team to develop future programs and goals.

  • Responsible for working with clinical staff regarding complex medical cases to assure services are clinically appropriate as well as ensuring services being reviewed and authorized are in accordance with corporate medical policy.

REQUIREMENTS: Education and Experience

  • Requires a Bachelor's in a health care field or related, additional years of supervisory experience may be considered in lieu of formal education

  • Requires 3 years of experience in health care/health insurance or related field

  • Requires professional verbal and written communications skills and has experience communicating with physicians to explain complex medical situations

PREFERRED:

  • Current Missouri or Kansas RN license in good standing

  • Three (3) years experience coding with CPC certification

  • Previous leadership experience

  • Experience in inpatient utilization management within the payer industry

May require some weekends to accommodate urgent weekend authorization requests. (Approximately 1 per month)

GEHA is an Equal Opportunity Employer. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. Our company's corporate headquarters is located in Lee's Summit near Douglas Rd and I-470 with a total of five locations in the Kansas City metropolitan area.

Company
GEHA
Posted
04/27/2022
Salary Range
$23,000.00 - $44,000.00
per Year
Salary range estimated by
salary estimation provided by zippia
Location
Lees Summit, MO, 64081, US