25 Jan
Manager, Utilization Management
Missouri, Jeffersoncity , 65101 Jeffersoncity USA

Vacancy expired!

It’s Time For A Change…Your Future Evolves HereEvolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.Are we growing? Absolutely – about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and one of the “50 Great Places to Work” in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.What You’ll Be Doing:Who You’ll Be Working With:The Manager, Utilization Management oversees daily utilization management and directs the medical care of our members on behalf of our clients. This person works collaboratively with the Associate and Market Medical directors as well as the other medical management stake holders such as provider relations, quality management, compliance, member services, benefits and claims management.What You’ll Be Doing:Accountable to the Market Director, Clinical Operations and the Evolent Utilization management to monitor the utilization management of resources of the local client network and implementation of initiatives and educational processes to achieve targeted utilization management results established by the client.Accountable for hiring, onboarding and directing local, market focused utilization management staff.Monitor staffing ratios and identifying the need for growth of the utilization management team to promote membership growth and client requirementsDevelops local systems and aligns with Evolent processes for the assumption of utilization management assignments by the provider network to create alignment and accountabilityMonitor and drive improvement of utilization management metrics over client baseline.Monitor, drive, and quality improve daily utilization management work flows managed directly or indirectly on behalf of the client.Monitoring the timeliness and accuracy of utilization management data and reporting to meet requirements of applicable regulatory agencies.Implement and manage the utilization management work plan to meet monthly, quarterly and annual deliverables as per client contract, local, and federal regulatory requirementsDevelopment and implementation of appropriate utilization management programs, policies, and process improvements.accountable for ensuring rigorous, consistent, and disciplined design and execution of integration with the Evolent Health Quality Management program.Using data analysis to identify opportunities for quality improvement.Developing and adopting best practice methodologies and training programs for utilization management tools and techniques.accountable for directing activities related to special projects for utilization management and use of project resources.reliable for working a case load from the UM que for the marketPreferred Experience We Look For:2-4 years of operations and Utilization Management experience in a population management or managed care/insurance or hospital medical management department setting.Previous management experienceSophisticated knowledge of clinical operations in managed care, including quality management, outcomes, provider network, claims, financial management, care management policies, disease state and population management, members’ rights and responsibilities, and ability to quickly assess client practices.Experience in consulting or services organizations with a proven ability to manage client relationships and achieve change within another organization.reliable for driving and achieving a high standard of quality utilization management and results.Working knowledge of clinical quality metrics such as HEDIS, NCQA and National Quality Forum metrics.Technical requirements:Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.Compensation Range: The typical range of employees within the compensation grade of this position is $80,000 - $100,000. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.

Vacancy expired!


Related jobs

Report job