Benefit Management Operations Supervisor

CareOregon

2d•Remote

About The Position

This position is responsible for supervising daily benefit management operations and staff. Work includes implementing and monitoring processes and procedures that support Care Management program goals and organizational strategic objectives, as well as ensuring staff are performing at required competency and production levels. This position may perform the tasks of non-clinical Medical Management staff during times of coverage needs or reassignment of work.

Requirements

Minimum 2 years’ experience in practice management of primary or specialty care and/or Health Plan Operations that includes utilization review activity
Knowledge of utilization management practice principles and industry standard criteria
Knowledge of Oregon Health Plan (OHP) benefit package including rules and regulations that pertain to health plan operations
Knowledge of Oregon Medical Assistance Program (MAP)
Knowledge of the Centers for Medicare and Medicaid Services (CMS) rules and regulations, including Medicare A and B benefits and regulations governing Medicare Advantage plans
Knowledge of principles of managed care and utilization management
Knowledge of ICD-9, CPT, HCPCS coding
Ability to work with the department, stakeholders or customers to effectively resolve issues
Ability to use critical thinking skills in problem solving
Ability to manage multiple tasks and to remain flexible in a dynamic work environment
Ability to function autonomously and to effectively set priorities
Ability to present a positive and professional image
Ability to develop and implement processes and procedures
Ability to provide effective leadership and supervision to groups of people
Ability to read, write and verbally communicate effectively
Excellent customer service skills
Ability to use basic word processing, spreadsheet and programs and the ability to learn more complex programs
Ability to work effectively with diverse individuals and groups
Ability to learn, focus, understand, and evaluate information and determine appropriate actions
Ability to accept direction and feedback, as well as tolerate and manage stress
Ability to see, read, hear, speak clearly and perform repetitive finger and wrist movement for at least 6 hours/day

Nice To Haves

Minimum 1 year experience in a supervisory or lead position or completion of CareOregon’s Aspiring Leaders Program; lead roles preferably include regular assistance to a manager or supervisor in staff hiring, coaching, performance evaluation, and other supervisory tasks
Utilization management experience

Responsibilities

Identify opportunities to improve the program’s effectiveness and efficiency of work processes.
Implement, monitor and evaluate approved program changes.
Keep abreast of Oregon Health Plan (OHP), Medical Assistance Program (MAP), and Medicare rules and regulations; inform manager, staff and other stakeholders of changes that impact decisions and practice.
Ensure that services requests and authorizations are processed according to the (OHP) rules and regulations, Medicare regulations, and National and Local Coverage Determinations.
Develop process documentation and training materials as needed.
Provide orientation to new employees or provide oversight to staff who will provide the orientation.
Provide on-going training to address programmatic and staff needs in all areas of utilization management functions.
Make recommendations regarding the use of technologies that may enhance departmental performance and serve as a departmental resource for the implementation of any such technology.
Keep current on system process and issues, including QNXT functions and SharePoint, including upgrades and upgrade testing.
Act as a resource for staff and Medical Directors.
Work with identified CareOregon staff and departments to find opportunities to support financial impact initiatives.
Work collaboratively with other CareOregon departments.
Ensure that CareOregon authorization decisions are based on coverage rules.
Remain informed about current processes and tasks performed by prior authorization, referral, appeal, claim review, and concurrent review staff.
Stay current with work processes by providing periodic coverage for staff assignments.
Work with staff to determine coverage in the event of unplanned absences.
Cover an assignment when necessary.
Supervise team and recommend team direction and goals in alignment with the organizational mission, vision, and values.
Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens.
Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.
Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.
Train, supervise, motivate, and coach employees; provide support toward employee development.
Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.
Ensure team adheres to department and organizational standards, policies, and procedures.
Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).
Perform supervisory tasks in collaboration with Human Resources as needed.

Benefits

competitive pay
bonus opportunity
medical, dental, vision, life, AD&D, and disability insurance
health savings account
flexible spending account(s)
lifestyle spending account
employee assistance program
wellness program
discounts
multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)
strong retirement plan with employer contributions
PTO
Paid State Sick Time
paid holidays
volunteer time
jury duty
bereavement leave