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Manager, Medical Management

Remote:

Full Remote

Contract:

Full time

Experience:

Senior (5-10 years)

Work from:

United States

Offer summary

Qualifications:

Bachelor's degree or equivalent experience, 5-7 years of case management experience, 3 years of Supervisor level experience, Experience in training and workflow implementation, Strong skills in analyzing organizational metrics.

Key responsabilities:

Develop and manage the Value team
Oversee Clinical staff and strategies
Analyze and refine client impact reporting
Monitor production processes and outputs
Lead coaching, development, and feedback for staff

Allied Benefit Systems, LLC Unicorn https://www.alliedbenefit.com/

501 - 1000 Employees

See more Allied Benefit Systems, LLC offers

Job description

Your missions

Position Summary

The Manager, Medical Management is responsible for developing and managing a Value team supporting Allied’s Clinical Case Management, Cost Containment, and Member Advocacy arms within the organization as well as a Clinical team. They are an innovative leader with the ability to evaluate processes, identify trends, collaborate with internal and external teams and vendors, and ensure member impact reporting and narratives are communicated to clients, brokers, and stop-loss carriers.

Essential Functions

Develops and manages a team of individuals that influence Cost Containment, Quality & Training, and Impact reporting for the Medical Management departments.
Manage Clinical staff responsible for enhancing strategy-specific processes under the prevention, advocacy, and cost containment teams.
Analyze and refine client level impact reporting to promote the value of Allied Care Medical Management
Review dashboard data as needed for patterns and trends to promote strategic focus specific to each block of business, industry, client, and prospects.
Identify and guide the Value team on new opportunities to impact ASO Self-Funded and Co-Sourcing Partially Self-Funded Clients based on trends in utilization, demographics, and claims costs.
Evaluate feedback shared by the Value team for additional and future enhancements of strategies and processes.
Assess recommendations shared by internal and external stakeholders to amplify Allied Care’s Medical Management’s service offerings.
Develop new opportunities for proprietary, data-driven strategies specific to Allied’s member population.
Collaborate with Allied’s Growth Marketing team to design and enhance Medical Management industry marketing materials, impact reporting, and case studies unique to the TPA market.
Maintain oversight of new and improved quality standards as they are implemented.
Monitor production processes and outputs to ensure they meet standards.
Establish and manage auditing procedures and metrics for the Value team to assure consistent standards are met.
Strategize regularly with the Medical Management leadership on the management and progress of the various caseload queues, including member and claim scenarios.
Promotes an environment of continuous improvement and collaboration while assisting in troubleshooting and resolving escalated issues.
Supports Medical Management leadership team in developing and presenting ongoing department and organizational learning.
Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.
Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed.
Actively engage, coach, counsel and provide timely, and constructive performance feedback.
Other duties as assigned.

EDUCATION

Bachelor's degree or equivalent work experience required.

Experience & Skills

5-7 years of case management experience, preferably from a third-party administrator, carrier, or within the healthcare industry required.
At least 3 years’ experience at a Supervisor level managing teams of employees with a variety of background and tenure.
Ability to monitor and prioritize multiple deadlines and projects simultaneously.
Experience with training, such as onboarding, workflow implementation, pre-recorded sessions, etc. preferred.
Experience reading, analyzing, and reviewing organizational metrics and data, preferred.
Highly skilled in written and verbal communication, also including client focused presentations.

POSITION COMPETENCIES

Accountability
Communication
Action Oriented
Timely Decision Making
Building Relationships/Shaping Culture
Customer Focus

PHYSICAL DEMANDS

This is a standard desk role – long periods of sitting and working on a computer are required.

WORK ENVIRONMENT

Remote

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.