UM Manager

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Imperial Management Administrators Services

Responsible for providing operational leadership to the day to day function of the UM/Prior Authorization Team. The UM Manager will ensure that the team complies with Federal, State, Health Plan and NCQA requirements

ESSENTIAL JOB FUNCTIONS:

1. Collaborating with clinical and non-clinical personnel providing timely care which complies with generally accepted standards of clinical practice.

2. Assigns work schedules, delegates reviews, provides direction on review priorities, meets the demands of internal and external partners, and ensures staff achieve performance goals and adherence to company policies.

3. Ensures that the UM team is properly trained to conduct medical necessity reviews on incoming pre-service/prior authorization, on routine and expedited referrals requests in compliance with Federal, State, Health Plan and NCQA standards.

4. Ensures UM team documents on the medical management system timely, all supporting clinical information, outreach attempts and criteria used to make a determination.

5. Monitors, tracks, and reports any inappropriate referral patterns to the UM Medical Director and Director of Clinical Services

6. Serves as a subject matter expert on appropriate use, interpretation and documentation of clinical criteria in the review process using NCD, LCD, Health Plan Medical Guidelines, MCG, NCCN, etc.

7. Facilitates an atmosphere of interactive management and the development of collegial relationships among personnel and others, serving as a link between clinical and the healthcare disciplines

8. Collaboration with clinical personnel and members of other disciplines, participates in an organizational policy and procedure formulation and decision making, accepts organizational accountability for services provided, and evaluates the quality and appropriateness of care.

EDUCATION/EXPERIENCE:

· Bachelor’s degree in a health care related field

· At least 2 years of management experience in a Medical Group, MSO, Hospital, or Health Plan setting

· At least 5 years of experience in UM/Managed Care setting

To apply for this job please visit forms.office.com.