Supervisor Pre-Service UM Non-Clinical

Overview

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

One Community. One Mission. One California 

Responsibilities

***This position is work from home within California.

Position Summary:

Oversees the day-to-day processing of referral determinations (authorizations), including supervision of personnel and monitoring of production and quality standards under the direction of the Utilization Management Manager. In conjunction with the Utilization Management Manager, plans, directs and implements procedures and processes to ensure timely and accurate processing of authorizations. This is a working supervisory position responsible for specific departmental operations. The position is also required to participate in the duties performed by the production staff.

Responsibilities may include:- Support the Manager of UM Pre-Service (Non-Clinical), support the Delegation Oversight team and UM Director in the development and/or updating of departmental manuals, procedures and processing standards relative to the authorization process.- Supervise UM Coordinators and Authorization Indexers, planning, assigning, and directing Coordinator work as necessary including ensuring quality and compliance benchmarks are met, timely performance evaluations, disciplinary actions and identification of training needs.- Core Admin Platform Software Super-user and ensure training of staff- Ensure maintenance of all communication lines, including returning phone calls to members, physicians, and Health Plans and follow up with requests.- Maintain authorization production standards and statistics, ensuring production meets timeliness goals established by health plans, DOC, HCFA and contractual arrangements; reports to management on a daily basis.- Communicate, coordinate and interact with Dignity Health MSO personnel, provider office/facility staff, members, and health plan representatives, ensuring the integrity and accuracy of all work that is processed by the UM staff.- Maintain regulatory Turn Around Time Standards per CMS (Seniors) and ICE (Commercial)- Maintain all reference materials that are provided by the supervisor, manager or director.- Escalate to management any compliance and/or authorization backlog issues.- Partner with leadership to improve and facilitate work flows that will enhance UM productivity.- Responsible for running daily integrity reports and UM quality monitors as assigned.- Responsible for monitoring Deferred Authorization maintenance, tracking, and assigning coordinator follow up.- Responsible for oversight of staff timekeeping practices include management of PTO requests, timecard approval, and rolling year attendance reports as needed.

Qualifications

Minimum Qualifications:

- 3+ years of health care experience, including 2+ years of authorization processing experience in a managed care environment.- Previous experience in a lead or supervisory role with direct reports.- High School Diploma or Equivalent required.

Preferred Qualifications:

- 5+ years of above experience preferred.- BA Degree in Healthcare administration or related field preferred.