Utilization Management Out-Patient Manager

Allegiance Sheridan , WY 82801

Posted 2 months ago

Must Relocate to Missoula Montana

Allegiance Benefit Plan Management, Inc. is a national leader in the administration of innovative and customized employee benefit plans for companies, associations and government agencies across the country. Our highly-trained and experienced team of claims professionals, nurses, doctors, attorneys, accountants, managers, and systems & benefits experts all take great pride in providing outstanding service that dramatically improves the experience, outcomes and cost of healthcare for employers and their members. While Allegiance's goal is to provide clients with the highest level of service, we know that ultimately the products and services we administer serve the needs of individuals and their families. In all that we do, we realize that ours is a business focused on benefiting people and helping to improve their healthcare journey.

REPORTS TO: Director of Care Management Services LOCATION: Missoula

FSLA STATUS: Exempt

POSITION RESPONSIBILITIES:

The Nurse Manager will lead and support the outpatient Utilization Management team and reinforce the work under the general supervision of the Director of Care Management, to evaluate outpatient services, conduct reviews, and respond to appeals. You will ensure that applicable clinical criteria are applied correctly in conjunction with the Outpatient Medical Management Team.

The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and be respectful and courteous in the conduct of this position.

ESSENTIAL JOB FUNCTIONS:

Essential job functions include the following. Other functions may be assigned as business conditions change.

  • Provides and/or facilitates clinical management and/or other related activities and serves as a resource to other team members while demonstrating fiscal responsibility and maintaining the highest standards of care and ensuring compliance with all policies, procedures, and regulatory requirements. Promotes interdisciplinary health plan consumers/beneficiaries' care planning and supports questions from nurses in addition to agency, physician, member/family calls, etc.

  • Hires, trains, and conducts performance reviews, and directs the workflow for the team. This position is also accountable for participating in the development and implementation of department goals and objectives. Ensures all goals and objectives are met timely and effectively.

  • Serves as a resource and provides leadership assistance to achieve optimal clinical, operational, financial, and member/provider satisfaction outcomes.

  • Acts as a consultant within the organization.

  • Reviews documentation and provides feedback to clinicians to ensure accurate assessment and review data, medical records reflect compliance with medical necessity.

  • Provide education and training for team members and ensures appropriate on-boarding and training of new staff members.

  • Accountable for measuring, monitoring, and managing the quality of process, achievement of key performance indicators and organizational clinical performance.

  • Prepares and submits any required status or summary reports in a timely manner.

  • Work collaboratively and communicate effectively to provide additional support for other departmental tasks and duties.

  • Acts as a team player to help develop and reinforce colleagues understanding of necessary authorization/ denial requirements and supporting documentation.

  • Other clinical and management duties as required.

PHYSICAL WORKING CONDITIONS:

Physical requirements are representative of those that must be met to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Sitting 80% Reaching Minimal

Standing 10% Manual Dexterity Ability to type/keyboard

Walking 10% Telephone High Degree

Kneeling As needed Computer Screen High Degree

Bending As needed Lifting 25 pounds

JOB SPECIFICATIONS:

To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Licensure:

Requires current Montana (or compact state) Registered Nurse (RN) license in good standing.

Other Experience:

Must possess a strong knowledge of nursing supervision/management. Utilization management or case management experience preferred.

Requires excellent leadership skills and an ability to interact well across departments, facilities and organizations. Excellent organizational, human relations, and communication skills are required to maintain good rapport and effective working relationships with internal and external customers.

5 years utilization review/management or case management experience preferred. Computer skills such as MS Office products - Outlook, Excel, Word, Adobe and the ability to work within care management systems.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel as classified. By signing this statement, the employee understands the scope of their licensure and will practice within the scope of that licensure.

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Utilization Management Out-Patient Manager

Allegiance