The Supervisor Medical Management supervises and leads the Utilization and Case Management Departments, including planning, organizing, and coordinating the activities of the Utilization Management and Case Management programs. Requirements include demonstrating mastery of the managed care environment, TRICARE, DoD, Utilization Management and Case Management standards and programs, and USFHP Policies and Procedures. Ability to develop and manage within budgetary guidelines. This position includes daily clinical discretionary capacity that has potential to affect the financial well being of the health plan.
Develop and train intake staff
Manage staff of Intake Coordinators during business expansion
Monitor Case Load and distribution of all Intake Coordinators
Provide internal chart audits
Answers incoming calls and retrieves phone mail requests as time permits to manage phone stats
Prepares Utilization Management reports, letters, and memos as requested
Acts as liaison for customer service and other outside entities as required
Collaborates with other departments within the organization
Identifies areas of potential improvement in workflow
Receive process and complete data entry of demographic information for all referral and authorization requests from providers via fax or phone and as appropriate, forward to precertification nurse/care manager/case manager.
Begin on-line process utilizing skills of typing, medical terminology and ICD/CPT coding
Adhere to NCQA and other applicable standards
Follows CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPPA)
Attend monthly departmental meetings and/or interdepartmental meetings as appropriate
Ability to work a flexible work schedule including evenings and weekends
High school diploma
Working Knowledge of Medical Terminology and CPT background
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.