The Clinical Manager - Utilization Management (UM) is responsible for assisting the Director, UM with the planning, development, implementation and ongoing evaluation of projects and programs related to the Independent Health UM program. Responsibilities include assessing for opportunities to control medical expense and consulting with senior leadership to assure benefits support health and medical management strategies. The clinical manager is also responsible for direct supervision and support of the UM clinical and support teams, as well as ongoing support of corporate initiatives. Responsibilities also include promoting teamwork while accentuating a customer focused, performance based work environment. The UM Manager will help facilitate workflow and provide leadership and direction to the team. Additional responsibilities include, but are not limited to, regulatory requirements monitoring, department productivity and efficacy statistics, reporting HIPAA issues, coordinating staff schedules, and continuously monitoring our processes for optimal outcomes. The clinical manager will work closely with all areas of medical management, health management, medical directors, etc., to ensure proper staffing, quality delivery, appropriate training and staff development. The clinical manager, will be directly responsible for the support, compliance (NCQA, DFS, CMS, DOH, etc.) and overall performance of their teams.
Registered nurse (RN), licensed clinical social worker, or licensed practical nurse (LPN) with current and unrestricted license in the State of New York required. Utilization/Medical Management Certification preferred.
Minimum of five (5) years of experience in clinical setting required;
Minimum of three (3) years UM specific experience required.
Minimum of four (4) years management experience, coupled with demonstrated success in program development, and staff coaching and development required.
Knowledge of managed care policies, procedures, and regulations relevant to the department’s target population.
Excellent verbal, written and interpersonal communication skills required.
Excellent organizational, time management, and leadership skills.
Proven ability to work effectively as a member and leader of a multi-disciplinary team. Ability to lead or influence others positively to achieve desired work results and ability to work effectively with others to achieve desired goals.
Exhibits creativity and self motivation, with ability to effectively solve problems as they arise.
Demonstrated ability to collect and analyze outcomes against established benchmarks/standards.
Demonstrated ability to continuously seek, identify, and implement process improvement strategies to increase and improve departmental performance.
Solid PC skills required (Word, Excel and PowerPoint).
Proven examples of displaying the IH values: Passion, Caring, Collaborative, Respectful and Accountable.
Maintains confidentiality and uses only the minimum amount of protected health information (PHI) necessary to accomplish job related responsibilities.