Job Description
Competitive Compensation & Benefits Package!Position eligible for –Annual incentive bonus planMedical, dental, and vision insurance with low deductible/low cost health planGenerous vacation and sick time accrual12 paid holidaysState Retirement (pension plan)401(k) Plan with employer matchCompany paid life and disability insuranceWellness ProgramsSee attachment for additional details.Office Location: Flexible for any of our office locations; Hybrid or Remote Option AvailableProjected Hiring Range: Depending on Experience Closing Date: Open Until FilledPrimary Purpose of Position:The UM Manager is responsible for proactive and focused leadership, clinical, supervisory and operational oversight of UM activities and responsibilities. This position requires a proactive and focused risk management approach to leadership and oversight. The Manager is responsible for consistent implementation of systems and operational guidelines which support quality and clinically sound utilization management. This role requires strong and positive leadership skills, strong clinical skills, a collaborative approach to problem-solving and a strong understanding of quality improvement techniques and processes.Role and Responsibilities:The UM Manager is responsible for (though not limited to):Administrative/Operational LeadershipProvides leadership, in collaboration with other managers/leaders, to promote strong cohesiveness among all agency employees regardless of department, role or office location…promotes one vision, one voiceWorks closely with other UM Managers to ensure consistent workflows and good communication between teamsEnsures strong collaborative problem-solving with other departmentsEnsures consistent implementation of established work processes, with focused effort on identifying and remediating potential issues as proactively as possibleAssists in implementation and management of clinical and administrative initiativesActively collaborates with other agencies, organizations, and both formal and informal community resources to promote quality outcomes for our consumersMonitors trends in individual and team performance through review of QI data, use of available reports, direct observation and monitoring of work, etc.Monitors high risk situations and intervenes quickly to prevent or quickly address concerns/issuesIdentifies training/support needs for team members and ensures that needed training/support is receivedPromotes customer/community stakeholder satisfaction through ongoing communication, refinement of work processes as needed, and timely follow-up on any concerns/issuesEnsures that opportunities for increased efficiency are identified and acted onPromotes a positive work environment by exemplifying a positive, solution focused, can-do attitude and fostering the same in all team membersContinuous Quality ImprovementEnsures active QI process which focuses on proactive management of risks and qualityEnsures that QI/performance data is maintained, reviewed and shared with Supervisors, facilitating discussion of accomplishments and opportunities for quality enhancementEnsures that QI efforts are well documented at all levels and that all identified issues or opportunities for quality enhancement/increased efficiency are followed up on in a timely manner.Ensures timely submission of accurate QI dataProactively monitors performance of direct reports and their team(s) through observation and review of service documentation, identifying and remediating identified issues in a timely mannerUtilizes and models person centered planning methods/strategies as appropriate during supervision/training, including use of person centered thinking toolsPromotes the ongoing assessment of goals and planning which supports attainment of personal outcomesAssists in development/revision of clinical and operational systems and guidelines to implement and reflect the agency’s focus on operational excellence, outcomes-based service philosophy as well as service system regulations and standardsEnsures that all grievances and provider concerns are reported and/or resolved in a timely mannerParticipates in assigned committees/task forces to promote best practices and to ensure open communicationParticipates in internal/external reviews of services and ensures follow-up for any unsatisfactory areas noted.SupervisionProvides direct supervision of Utilization Management staff as indicatedEnsures that all team members receive strategic coaching/training/supervision to develop and maintain competencyEnsures that the team has needed knowledge/skill to actively support UM activities including addressing issues/concerns and to train UM dutiesMonitors the work of employees supervised through regular direct observation/review of job performance and provides needed direction/guidance, including timely supervisory counseling and/or disciplinary action when neededReviews/approves all requested expenditures (e.g. travel, training, purchases) to ensure efficient use of resourcesObjectively and thoroughly completes all employee performance reviews (probationary and annual) by due dateEnsures that all team members receive ongoing trainings of changes in state, agency, or departmental regulations, policies, procedures, and operational guidelinesEnsures that meetings/supervision sessions are documentedFollows, and ensures that team members supervised follow established protocols for documentation of supervision/training, recommendation of regular status at the end of the probationary period, and other personnel dutiesEnsures proactive communication with Assistant Director and Director of Utilization ManagementEnsures effective communication between contracted staff and Partners staffKnowledge, Skills and Abilities:Comprehensive knowledge of the assessment and treatment of Medicaid population needs.Comprehensive knowledge of the Medicaid PH service array provided through the network of providersKnowledge of the unique challenges faced by the MH/SU/IDD population, treatment interventions and evidence based practices for these populations with co-occurring medical disordersKnowledge of Tailored Plan, Public Health, Clinical Policy and clinical guidelines as they relate to authorization of servicesStrong critical thinking skillsWorking knowledge of laws, regulations, and program practices/requirements impacting members and familiesAbility to establish and maintain a positive, productive and high performing work environmentAbility to coordinate, train and oversee duties of others to ensure high quality servicesKnowledge of and ability to facilitate a continuous quality improvement processKnowledge of community resources and commitment to promote use of those resourcesAbility to provide effective and clinically sound consultation/education/training to othersAbility to use good judgment and make data-based decisionsAbility to establish and maintain positive and effective working relationships with others both within the agency and communityAbility to express directions, comments and opinions clearly and concisely in oral and/or written form.Ability to understand and interpret complicated written material and verbal presentations.Skill and ability to demonstrate diplomacy as well as the ability to handle stressful situationsAbility to demonstrate initiative and effective, solution-focused, problem-solving skillsDetail-oriented, able to organize multiple tasks and priorities and to effectively manage projects from start to finishAbility to make prompt independent decisions based upon relevant facts, to establish rapport and maintain effective working relationshipsAbility to lead by exampleExcellent computer skills (WORD, Excel, Microsoft Outlook, Internet)Ability to assess personal strengths/needs and identify needed training to promote own professional developmentEducation/Experience Required:Licensed to practice as a Registered Nurse in North Carolina, four (4) years of professional experience as an RN, and