Utilization Clinical Manager

Kepro Casper , WY

Posted 4 weeks ago

Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting. Kepro is seeking resumes for a highly experienced professional.

Utilization Clinical Manager

Candidates please take note. Kepro holds significant contracts with the federal government. As of December 8, 2021, Kepro will require its employees to be fully vaccinated against COVID-19 as required by Executive Order 14042. New hires must be fully vaccinated as of their start date and provide proof of vaccination during the onboarding process. Medical and religious accommodations are available to those who qualify.

Summary Description

Kepro seeks a Utilization Clinical Manager to oversee a team of supervisors and clinicians conducting the Utilization Review functions for Medicaid programs for the State of Wyoming. The Clinical Manager will collaborate on and support all areas of Utilization Management as well as assist with training and management of assigned workloads to ensure compliance with performance (timeline and quality) standards. The Clinical Manager coordinates with leadership on decisions and issues, and communicates with stakeholders regarding clinical matters.

Accountabilities

  • Oversee, coordinate, and monitor all Clinical team/assessor activities.
  • Directly manage all supervisors who manage teams of RNs.
  • This role will coordinate with the Agency on UM decisions, issues, and communicate with providers and inpatient facilities regarding utilization review decisions and other clinical matters.
  • Ensure adequate staffing and contractual service levels are adhered to by implementing and monitoring clinical staff productivity and performance indicators. Maintain effective team member relations.
  • Lead team members in improving skills, creativity, and problem-solving.
  • Develop policies and procedures, interpretive guidelines and inter-rater reliability activities to ensure consistent application of assessments.
  • Develop communication and training methods to enhance skill set, define skill gaps and remediation efforts.
  • Represent the clinical department by participating on committees, task forces, work groups.
  • Handle escalated issues/concerns and identify opportunities for improvement.
  • Maintain professional relationships with provider community and external customers.
  • Provides reports of compliance and other activities.
  • Intermittent travel for quality assurance and other purposes.
  • Represent the Clinical teams performance, goals, upcoming activities, risks and overall status at various internal and external venues, as requested.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

Qualifications

  • Bachelors degree in health and human services or medical field required, Masters preferred.
  • Active Non-restricted, Wyoming RN license required.

Knowledge, Skills, Abilities

  • Demonstrated proficiency in MS Office applications.
  • Successful record leading clinical or health and human services professionals.
  • Ability to develop best practice policies and procedures and systems to support new work that meets performance expectations.
  • Ability to work collaboratively with other leadership team members to achieve department goals.
  • Ability to professionally respond to change and handle multiple and changing priorities with sometimes conflicting deadlines.

Experience

  • 5+ years of clinical experience required.
  • 5+ years staff/workload management experience required.
  • Experience with WY Medicaid programs, strongly preferred.
  • Expertise assessing individuals with disabilities and vulnerable populations preferred.

Mental and Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

Kepro offers challenging careers, excellent benefits and opportunities for advancement. For consideration, please submit resume and cover letter with salary requirements. Only those candidates identified for an interview will be contacted. No Phone Calls Please. Visit our website at www.Kepro.com for more information on the Kepro Family of Companies.

EOE AA M/F/Vet/Disability

Kepro is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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Utilization Clinical Manager

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