Supervisor, Medical Management

SCAN Health Insurance•Long Beach, CA

9d•$70,304 - $84,143•Remote

About The Position

Oversee daily operations and activities performed by non-clinical staff, including Prior Authorization, Hospital Notification, and Concurrent Review support, to ensure the provision of appropriate utilization of services and efficient and quality service to members and providers. This role involves supervising and coordinating day-to-day operations of the Medical Management department non-licensed staff, demonstrating oversight of the authorization process, hospital notification and census management. The position also requires completing quality review and auditing to ensure compliance with all regulatory and compliance standards, supporting ongoing department process improvements through the PDSA practice by timely communication and education to the team, and ensuring staff success by timely communication of job expectations and monitoring of goal progress by coaching and counseling employees. The role also includes maintaining staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; and developing personal growth opportunities. Building effective professional relationships with providers and other internal and external partners is key, utilizing excellent verbal and written communication skills, developing trust, meeting timelines, respecting cultural differences, using active listening skills, and maintaining confidentiality. The role also promotes compliance with and adherence to all regulatory and quality standards including but not limited to: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and accreditation bodies’ standards such as the National Committee for Quality Assurance (NCQA) as it relates to Medical Management's activities. The company is looking for individuals who are curious about AI and its power to transform operations and member service. The role requires active support of SCAN’s Vision and Goals, with other duties as assigned.

Requirements

Associate's Degree or equivalent experience
2-3 years of related experience in a Medicare Advantage Health Plan Utilization Management
At least 1 year of leadership experience
Knowledge of the field's policies, procedures, and practices
Leadership - Basic skills to develops others
Problem Solving - Basic problem-solving skills
Communication - Good communication and interpersonal skill
A background check is required.

Nice To Haves

Curious about AI and its power to transform how we operate and serve our members.

Responsibilities

Supervise and coordinate day-to-day operations of the Medical Management department non-licensed staff
Demonstrate oversight of the authorization process, hospital notification and census management
Complete quality review and auditing to ensure compliance with all regulatory and compliance standards
Support ongoing department process improvements through the PDSA practice by timely communication and education to the team
Ensures staff success by timely communication of job expectations and monitoring of goal progress by coaching and counseling employees; initiating, coordinating, and enforcing systems, policies, and procedures
Maintain staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities
Build effective professional relationships with providers and other internal and external partners by using excellent verbal and written communication skills, developing trust, meeting timelines, respecting cultural differences, using active listening skills, and maintaining confidentiality
Promote compliance with and adheres to all regulatory and quality standards including but not limited to: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and accreditation bodies’ standards such as the National Committee for Quality Assurance (NCQA) as it relates to Medical Management's activities
Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.

Benefits

Base salary range: $70,304 to $84,143 per year
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
Excellent 401(k) Retirement Saving Plan with employer match and contribution
Robust employee recognition program
Tuition reimbursement
An opportunity to become part of a team that makes a difference to our members and our community every day!
A competitive compensation and benefits program
An excellent Retirement Savings program
A work-life balance