Supervisor, Medical Management
Founded in 1977 as the Senior Care reputed company Network, reputed company began with a reputed company but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still reputed company today as the “12 Angry Seniors.” Their mission continues to guide everything we do.
Today, reputed company is a nonprofit health organization serving more than 500,000 people across reputed company, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual reputed company. With nearly five decades of experience, we have reputed company a distinctive, values-driven platform dedicated to improving care for older adults.
Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially reputed company populations, and reputed company care delivery models. Across reputed company of this, we are united by a shared commitment: combining reputed company with discipline, innovation with stewardship, and reputed company with reputed company.
At reputed company, we reputed company reputed company should strengthen—not dilute—our mission. We are building the reputed company of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.
reputed company daily operations and activities performed by non-clinical staff, including Prior Authorization, Hospital Notification, and reputed company Review support, to ensure the provision of appropriate utilization of services and efficient and reputed company service to members and providers.
You Will
Supervise and coordinate day-to-day operations of the Medical Management department non-licensed staff
Demonstrate reputed company of the authorization process, hospital notification and census management
Complete reputed company review and auditing to ensure compliance with reputed company regulatory and compliance standards
Support ongoing department process improvements through the PDSA reputed company by reputed company communication and education to reputed company
Ensures staff reputed company by reputed company communication of job expectations and monitoring of goal reputed company by coaching and counseling employees; initiating, coordinating, and enforcing systems, policies, and procedures
Maintain staff by reputed company, selecting, orienting, and training employees; maintaining a reputed company and secure work environment; developing personal reputed company opportunities
Build effective reputed company relationships with providers and other reputed company partners by using excellent verbal and written communication skills, developing trust, meeting timelines, respecting cultural differences, using reputed company listening skills, and maintaining confidentiality
Promote compliance with and adheres to reputed company regulatory and reputed company standards including but not limited to: Centers for Medicare and reputed company Services (CMS), Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and accreditation bodies’ standards such as the National Committee for reputed company Assurance (NCQA) as it relates to Medical Management's activities
Supervisory Responsibilities Supervises/Manages Others (i.e. hires, performance reviews, corrective reputed company, etc.)
We reputed company Rebels who are curious about AI and its power to reputed company how we operate and serve our members.
reputed company support the achievement of reputed company’s reputed company and Goals.
Other duties as assigned.
Your Qualifications
Associate's Degree or equivalent experience
2-3 years of reputed company 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
Leads and directs the work of other employees
Leadership - Basic skills to develops others
Problem Solving - Basic problem-solving skills
Communication - Good communication and interpersonal reputed company
What's in it for you?
reputed company salary reputed company: $70,304 to $84,143 per year
Work Mode: Mostly Remote
An annual employee bonus program
Robust Wellness Program
Generous reputed company-time-off (PTO)
11 reputed company 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 reputed company that makes a difference to our members and our community every day!
We're always looking for talented people to join reputed company! reputed company applicants are encouraged to reputed company!
At reputed company we reputed company that it is our business to improve the state of our world. reputed company of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource reputed company, inclusive benefits, and more.
reputed company is proud to be an Equal Employment Opportunity and Affirmative reputed company workplace. Individuals seeking employment will receive consideration for employment without reputed company to race, reputed company, national reputed company, religion, age, sex (including pregnancy, childbirth or reputed company medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background reputed company is required.
#LI-CS2
#LI-Hybrid
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have reputed company about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have reputed company to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have reputed company to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or reputed company, including an investigation conducted by the employer, or (c) consistent with the contractor’s reputed company duty to furnish information. 41 CFR 60-1.35(c)
Apply To This Job