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Manager, Medical Management

Remote: 
Full Remote
Contract: 
Full time
Experience: 
Senior (5-10 years)
Work from: 
United States

Offer summary

Qualifications:

Bachelor's degree or equivalent experience, 5-7 years of case management experience, 3 years of Supervisor level experience, Experience in training and workflow implementation, Strong skills in analyzing organizational metrics.

Key responsabilities:

  • Develop and manage the Value team
  • Oversee Clinical staff and strategies
  • Analyze and refine client impact reporting
  • Monitor production processes and outputs
  • Lead coaching, development, and feedback for staff
Allied Benefit Systems, LLC logo
Allied Benefit Systems, LLC Unicorn https://www.alliedbenefit.com/
501 - 1000 Employees
About Allied Benefit Systems, LLC
Allied is a national healthcare solutions company that works with organizations who choose to take control of their healthcare. We customize employer self-insurance benefits to align with individual choice and organizational need while integrating medical management innovations and cost-control strategies. With healthcare designed for people, employers never have to choose between price and the best-fit insurance products to protect employees and their families. Allied’s philosophy is to create a culture of health for our member organizations and their employees beyond simple, medical health. We integrate administrative services, care solutions and analytics to achieve better clinical, behavioral and social patient outcomes. Allied’s programs and benefit services are designed and structured to infuse value on every front – for employers and HR departments, for plan members and their families, for healthcare providers, and for us. We’re in this together, committed to your future.
See more Allied Benefit Systems, LLC offers

Job description

Position Summary

The Manager, Medical Management is responsible for developing and managing a Value team supporting Allied’s Clinical Case Management, Cost Containment, and Member Advocacy arms within the organization as well as a Clinical team. They are an innovative leader with the ability to evaluate processes, identify trends, collaborate with internal and external teams and vendors, and ensure member impact reporting and narratives are communicated to clients, brokers, and stop-loss carriers.

Essential Functions

  • Develops and manages a team of individuals that influence Cost Containment, Quality & Training, and Impact reporting for the Medical Management departments.
  • Manage Clinical staff responsible for enhancing strategy-specific processes under the prevention, advocacy, and cost containment teams.
  • Analyze and refine client level impact reporting to promote the value of Allied Care Medical Management
  • Review dashboard data as needed for patterns and trends to promote strategic focus specific to each block of business, industry, client, and prospects.
  • Identify and guide the Value team on new opportunities to impact ASO Self-Funded and Co-Sourcing Partially Self-Funded Clients based on trends in utilization, demographics, and claims costs.
  • Evaluate feedback shared by the Value team for additional and future enhancements of strategies and processes.
  • Assess recommendations shared by internal and external stakeholders to amplify Allied Care’s Medical Management’s service offerings.
  • Develop new opportunities for proprietary, data-driven strategies specific to Allied’s member population.
  • Collaborate with Allied’s Growth Marketing team to design and enhance Medical Management industry marketing materials, impact reporting, and case studies unique to the TPA market.
  • Maintain oversight of new and improved quality standards as they are implemented.
  • Monitor production processes and outputs to ensure they meet standards.
  • Establish and manage auditing procedures and metrics for the Value team to assure consistent standards are met.
  • Strategize regularly with the Medical Management leadership on the management and progress of the various caseload queues, including member and claim scenarios.
  • Promotes an environment of continuous improvement and collaboration while assisting in troubleshooting and resolving escalated issues.
  • Supports Medical Management leadership team in developing and presenting ongoing department and organizational learning.
  • Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.
  • Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed.
  • Actively engage, coach, counsel and provide timely, and constructive performance feedback.
  • Other duties as assigned.

EDUCATION

  • Bachelor's degree or equivalent work experience required.

Experience & Skills

  • 5-7 years of case management experience, preferably from a third-party administrator, carrier, or within the healthcare industry required.
  • At least 3 years’ experience at a Supervisor level managing teams of employees with a variety of background and tenure.
  • Ability to monitor and prioritize multiple deadlines and projects simultaneously.
  • Experience with training, such as onboarding, workflow implementation, pre-recorded sessions, etc. preferred.
  • Experience reading, analyzing, and reviewing organizational metrics and data, preferred.
  • Highly skilled in written and verbal communication, also including client focused presentations.

POSITION COMPETENCIES

  • Accountability
  • Communication
  • Action Oriented
  • Timely Decision Making
  • Building Relationships/Shaping Culture
  • Customer Focus

PHYSICAL DEMANDS

  • This is a standard desk role – long periods of sitting and working on a computer are required.

WORK ENVIRONMENT

  • Remote

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Required profile

Experience

Level of experience: Senior (5-10 years)
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Hard Skills

Process DevelopmentTrend AnalysisImpact AssessmentQuality MonitoringAudit ProcessesMedical Case ManagementCost ContainmentProject ManagementMarketing MaterialsData AnalysisBusiness Presentations

Other Skills

  • Problem Solving
  • Communication
  • Team Management
  • Coaching
  • Training And Development
  • Collaboration
Are you interested?

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