Manager I Utilization Management
Elevance Health

Job Info

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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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