Manager I Utilization Management at Elevance Health in Tampa, Florida

Posted in Other 6 days ago.





Job Description:

Simply Healthcare Plans, Inc. is a proud member of Elevance Health's family of brands. We are a licensed health maintenance organization with health plans for people enrolled in Medicaid and/or Medicare programs in Florida.



Manager I Utilization Management




Location: 11430 NW 20th ST, STE 300, Miami, FL 33172 or FL-TAMPA, 5411 SKY CENTER DR.


This position will take part in Elevance Health's hybrid workforce strategy which includes virtual work and 1-2 days physically in office per week. Our Ideal candidate will live within a 50-mile radius and a 1-hour commute to our Elevance Health major office (PulsePoint) in Miami or Tampa, FL. Elevance Health supports a hybrid workplace model with PulsePoint sites used for collaboration, community, and connection.


The Manager I Utilization Management is responsible for the daily management of the department.



How You Will Make an Impact



Primary duties may include, but are not limited to:


  • Supervises workflow and performance of associates.

  • Assists in coordination and development of UM quality initiatives.

  • Participates in strategic planning and budget processes.

  • Ensures compliance with departmental policies and procedures.

  • Works in conjunction with other UM staff to improve service quality initiatives, develop audit tools, and meet NMIS and other quality standards.

  • Provides quality control services such as call monitoring.

  • Develops and implements associate training.

  • Performs audits to monitor efficiency and compliance with policies.

  • Prepares reports.

  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.




Minimum Requirements:



  • Requires HS diploma or equivalent and a minimum of 4 years operational experience in a progressively complex customer service or call center; or any combination of education and experience which would provide an equivalent background.




Preferred Skills, Capabilities and Experiences:



  • RN or BSN preferred.

  • Experience in Long Term Care and Utilization Management Process preferred.



For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
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