Utilization Management Supervisor

COMPANY OVERVIEW

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health visit .

SUMMARY DESCRIPTION:

The Utilization Management Supervisor supports the business by overseeing the UM department staff and ensuring all compliance metrics are met. Has responsibility for leading/managing all aspects of a program such as planning coordination development implementation and auditing while prioritizing work resources and time. Ensures the end state of the project and/or business operations meets business objective(s) and that all deliverables and due dates are met. A highly collaborative process often requires managing relationships across the segments or multiple functional areas.

ESSENTIAL FUNCTIONS:

• Provides ongoing and random qualitative and quantitative analysis of the business process clinical systems tools and staff competencies using organizational performance measurements to ensure compliance with government regulations and corporate policy.
• Identifies documents and reports any transaction errors in a timely manner to ensure prompt resolution.
• Tracks and trends audit results providing feedback to management.
• Recommends corrective action and facilitates the implementation of remedial and process improvement plans. Implements training programs to increase role specific consistencies and efficiencies related to process workflows.
• Works directly with the Director of Utilization Management and front line staff to ensure competency and training or staff
• Identifies issues that may lead to compliance issues and works with Director to address them.
• Solicit and evaluate internal and external feedback to enhance continuous quality improvement.
• identify gaps and recommend enhancements related to new and/or existing products services and workflows based on broad view of the organization.
• Develops recommendations based on complex data and root cause analysis.

QUALIFICATIONS AND REQUIREMENTS:

JOB REQUIREMENTS:

• Previous (7-10years) experience in managed care Utilization Management roles
• Analytical and problem-solving skills
• Effective communications organizational and interpersonal skills
• Ability to work independently
• Effective computer skills including navigating multiple systems
• Proficiency with standard corporate software applications including Outlook MS Word Excel as well as some proprietary applications
• RN with unrestricted license

Zing Health offers the following benefits:

• A competitive salary based on the market
• Medical Dental and Vision
• Employer-Paid Life Insurance
• 401(K) match up to 4%
• Paid-Time-Off
• Several supplemental benefits are available including but not limited to Spouse Insurance Pet Insurance Critical Illness coverage ID Protection etc.