UM Team Leader
Company: MetroPlus Health Plan
Posted on: January 15, 2022
About NYC Health + HospitalsMetroPlus Health Plan provides the
highest quality healthcare services to residents of Bronx,
Brooklyn, Manhattan, Queens and Staten Island through a
comprehensive list of products, including, but not limited to, New
York State Medicaid Managed Care, Medicare, Child Health Plus,
Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
As a wholly-owned subsidiary of NYC Health + Hospitals, the largest
public health system in the United States, MetroPlus ' network
includes over 27,000 primary care providers, specialists and
participating clinics. For more than 30 years, MetroPlus has been
committed to building strong relationships with its members and
providers to enable New Yorkers to live their healthiest life.
The UM Team Leader, under the direction of the Senior Director of
Clinical Services provides oversight of the administration of
departmental utilization management activities.Salary commensurate
with experience and educationJob Description - Supervise staff
conduct utilization review.
- Oversee utilization review activities and ensures cases are
reviewed timely meeting NYS DOH and CMS regulatory standards.
- Support care management team development through direct staff
training and development activities
- Conduct utilization review and quality of care monitoring
activities in conjunction with care management program staff
- Quarterly audits of clinical staff
- Investigation and resolution of clinical claims related
- Support departmental training and clinical quality improvement
- Participate in the development, implementation, and evaluation of
performance improvement initiatives
- Ensure that standards of care delivery are consistent with
current professional standards and consistent with the Mission,
Vision and Values of the organization.
- Actively participate in Article 44/49 and CMS audit
- Participate in committees, as assigned.
- Other responsibilities as directed by the Senior Director of
Clinical Services or Chief Medical OfficerMinimum Qualifications -
At least 4 years of Utilization Management experience.
- Strong working knowledge of InterQual required.
- At least 1 year of supervisory experience. -
- Computer literacy and excellent written and oral communication
skills required. - Registered Nurse with a current New York State
License, Licensed Practical Nurse or Physician Assistant with
significant managed care experience.Professional Competencies
- Integrity and Trust
- Customer Focus
- Functional/Technical Skills
- Written/Oral Communications
- Ability to work in a fast-paced environment.
- High degree of diplomacy and tact.
Keywords: MetroPlus Health Plan, Newark , UM Team Leader, Hospitality & Tourism , Newark, New Jersey
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