Competitive Compensation & Benefits Package!
Position eligible for –
- Annual incentive bonus plan
- Medical, dental, and vision insurance with low deductible/low cost health plan
- Generous vacation and sick time accrual
- 12 paid holidays
- State Retirement (pension plan)
- 401(k) Plan with employer match
- Company paid life and disability insurance
- Wellness Programs
- Public Service Loan Forgiveness Qualifying Employer
Office Location: Hybrid/Remote Option Available; Flexible for any of Partners’ locations.
Projected Hiring Range: Depending on Experience
Closing Date: Open Until Filled
Primary Purpose of Position: The UM Manager is responsible for proactive and focused leadership, clinical, supervisory and operational oversight of UM activities and responsibilities. This position requires a proactive and focused risk management approach to leadership and oversight. The Manager is responsible for consistent implementation of systems and operational guidelines which support quality and clinically sound utilization management. This role requires strong and positive leadership skills, strong clinical skills, a collaborative approach to problem-solving and a strong understanding of quality improvement techniques and processes.
Role and Responsibilities:
The UM Manager is responsible for (though not limited to):
Administrative/Operational Leadership
- Provides leadership, in collaboration with other managers/leaders, to promote strong cohesiveness among all agency employees regardless of department, role or office location…promotes one vision, one voice
- Works closely with other UM Managers to ensure consistent workflows and good communication between teams
- Ensures strong collaborative problem-solving with other departments
- Ensures consistent implementation of established work processes, with focused effort on identifying and remediating potential issues as proactively as possible
- Assists in implementation and management of clinical and administrative initiatives
- Actively collaborates with other agencies, organizations, and both formal and informal community resources to promote quality outcomes for our consumers
- Monitors trends in individual and team performance through review of QI data, use of available reports, direct observation and monitoring of work, etc.
- Monitors high risk situations and intervenes quickly to prevent or quickly address concerns/issues
- Identifies training/support needs for team members and ensures that needed training/support is received
- Promotes customer/community stakeholder satisfaction through ongoing communication, refinement of work processes as needed, and timely follow-up on any concerns/issues
- Ensures that opportunities for increased efficiency are identified and acted on
- Promotes a positive work environment by exemplifying a positive, solution focused, can-do attitude and fostering the same in all team members
Continuous Quality Improvement
- Ensures active QI process which focuses on proactive management of risks and quality
- Ensures that QI/performance data is maintained, reviewed and shared with Supervisors, facilitating discussion of accomplishments and opportunities for quality enhancement
- Ensures that QI efforts are well documented at all levels and that all identified issues or opportunities for quality enhancement/increased efficiency are followed up on in a timely manner.
- Ensures timely submission of accurate QI data
- Proactively monitors performance of direct reports and their team(s) through observation and review of service documentation, identifying and remediating identified issues in a timely manner
- Utilizes and models person centered planning methods/strategies as appropriate during supervision/training, including use of person centered thinking tools
- Promotes the ongoing assessment of goals and planning which supports attainment of personal outcomes
- Assists in development/revision of clinical and operational systems and guidelines to implement and reflect the agency’s focus on operational excellence, outcomes-based service philosophy as well as service system regulations and standards
- Ensures that all grievances and provider concerns are reported and/or resolved in a timely manner
- Participates in assigned committees/task forces to promote best practices and to ensure open communication
- Participates in internal/external reviews of services and ensures follow-up for any unsatisfactory areas noted.
Supervision
- Provides direct supervision of Utilization Management staff as indicated
- Ensures that all team members receive strategic coaching/training/supervision to develop and maintain competency
- Ensures that the team has needed knowledge/skill to actively support UM activities including addressing issues/concerns and to train UM duties
- Monitors the work of employees supervised through regular direct observation/review of job performance and provides needed direction/guidance, including timely supervisory counseling and/or disciplinary action when needed
- Reviews/approves all requested expenditures (e.g. travel, training, purchases) to ensure efficient use of resources
- Objectively and thoroughly completes all employee performance reviews (probationary and annual) by due date
- Ensures that all team members receive ongoing trainings of changes in state, agency, or departmental regulations, policies, procedures, and operational guidelines
- Ensures that meetings/supervision sessions are documented
- Follows, and ensures that team members supervised follow established protocols for documentation of supervision/training, recommendation of regular status at the end of the probationary period, and other personnel duties
- Ensures proactive communication with Assistant Director and Director of Utilization Management
- Ensures effective communication between contracted staff and Partners staff
Knowledge, Skills and Abilities:
- Comprehensive knowledge of the assessment and treatment of Medicaid population needs.
- Comprehensive knowledge of the Medicaid PH service array provided through the network of providers
- Knowledge of the unique challenges faced by the MH/SU/IDD population, treatment interventions and evidence based practices for these populations with co-occurring medical disorders
- Knowledge of Tailored Plan, Public Health, Clinical Policy and clinical guidelines as they relate to authorization of services
- Strong critical thinking skills
- Working knowledge of laws, regulations, and program practices/requirements impacting members and families
- Ability to establish and maintain a positive, productive and high performing work environment
- Ability to coordinate, train and oversee duties of others to ensure high quality services
- Knowledge of and ability to facilitate a continuous quality improvement process
- Knowledge of community resources and commitment to promote use of those resources
- Ability to provide effective and clinically sound consultation/education/training to others
- Ability to use good judgment and make data-based decisions
- Ability to establish and maintain positive and effective working relationships with others both within the agency and community
- Ability to express directions, comments and opinions clearly and concisely in oral and/or written form.
- Ability to understand and interpret complicated written material and verbal presentations.
- Skill and ability to demonstrate diplomacy as well as the ability to handle stressful situations
- Ability to demonstrate initiative and effective, solution-focused, problem-solving skills
- Detail-oriented, able to organize multiple tasks and priorities and to effectively manage projects from start to finish
- Ability to make prompt independent decisions based upon relevant facts, to establish rapport and maintain effective working relationships
- Ability to lead by example
- Excellent computer skills (WORD, Excel, Microsoft Outlook, Internet)
- Ability to assess personal strengths/needs and identify needed training to promote own professional development
Education/Experience Required: Licensed to practice as a Registered Nurse in North Carolina, four (4) years of professional experience as an RN, and three (3) years of supervisory experience. Experience in public health or healthcare administration.
Education/Experience Preferred: Experience in Utilization Management, with quality improvement processes, person centered practices and data management. Experience working with individuals with behavioral health disorders or Individuals with Intellectual/Developmental Disorders.
Licensure/Certification Requirements: Licensed to practice as a Registered Nurse in North Carolina by the N. C. Board of Nursing. Employee is responsible for complying with respective licensure board’s continuing education/training requirements to maintain an active license.