Versant Health · 3 hours ago

Manager, Healthcare Operations

Albany, NY

Full-time

Remote

Mid, Senior Level

$85K/yr - $95K/yr

3+ years exp

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Responsibilities

Ensures adherence to departmental policy, medical policy, and member benefits in providing services that are medically appropriate, high quality, and cost effective

Handles all incoming utilization management requests in accordance with all statutory, regulatory, accreditation and contractual requirements

Ensures that utilization management cases are completed within the required timeliness requirements for Medicare, Medicaid, and Commercial lines of business

Analyzes data and information to identify business opportunities and implements change to improve departmental processes

Collaborate with key-stakeholders to improve cost-effectiveness across all platforms

Represents the Utilization Management department for client audits and case file reviews

Participates in client meetings to ensure that all client contractual performance guarantees and regulatory state requirements are met and adhered to

Supports member and provider appeals process as required

Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Develops and provides training and education to direct reports to support client requirements and regulatory standards governing the applicable line of business

Requires rotation to weekends to provide managerial oversight to staff working on the weekend

Partners with other members of the Utilization Management Leadership team to support operations and business requirements to meet changing business needs and improve efficiency and service.

Supports companywide strategic initiatives

Manages all incoming utilization management requests in accordance with all statutory, regulatory, accreditation and contractual requirements

Qualification

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Managed care experienceMedicare experienceMedicaid experienceLeadership experienceClaims experienceMicrosoft Office SuiteProject managementStrategic thinking

Required

Bachelor’s degree in the field of Business Administration, Information Systems, Computer Science, or a similar degree. Consideration of work experience in lieu of bachelor’s degree.

Minimum of 3 years of managed care experience with a healthcare payer organization

Minimum of 3 years of leadership experience in grievance & appeals

At least two (2) years of claims and/or contracting experience in a managed care environment.

Intermediate level with various software programs including Microsoft Office Suite (Excel, Word, PowerPoint, Visio, and Outlook)

Proven experience with government programs such as Medicare and Medicaid supporting utilization / medical management business operations

Experience working on multiple projects concurrently

Strong analytical and problem-solving skills