Utilization Manager in New York, NY at Vaco

Date Posted: 6/10/2021

Job Snapshot

Job Description

Department: Utilization Management
Staff Title: Manager of UM
Working Conditions: Full time (M-F) Office
Education:
► Associates degree
Experience:
► Two or more years of experience in UM
► Computer skills (Excel, Word, Outlook, Adobe)
► Excellent telephone, typing, and computer skills
► Excellent listening/oral communication skills and ability to build good working relationships with peers and
clients
► Sound judgment: knows when to seek guidance/direction and/or when to refer problems to management
► Ability to maintain high degree of confidential/privileged patient and proprietary business information
.Job Responsibilities: This list does not represent all responsibilities for this position. Candidate must understand and
be willing and able to assume roles and responsibilities other than these to meet the needs of the department and
NYCHSRO/MedReview in general.
► Call Center Management- Intake schedule, delegation compliance, performance standards and reporting.
Complaints, Appeals and Grievance- CAG. Quarterly repo1ting to QMC.
► Comprehension of the In-Contact Hosted Platform and the Business Requirement Document-BRD.
► Maintain BCP for Call Center.
► Client point of contact for membership concerns and contract services.
► Annual client survey release and QMC reporting.
► Annual collection of clients Summary Plan Description and updated Benefit Summary
► Oversight of all HUM letters and client specific details; name of TPA, address, phone numbers for HUM, fax
server groups etc.
► Knowledge of the HUM clients, their contracted services and professional fee schedule.
► Knowledge of clients MIS informatics and standard repo1ts.
► Ability to work with IT regarding services issues.
► Assist Physicians with navigating Case Trakker.
► Schedule QA meetings with staff and record minutes.
► Maintain Log with Department in office staff PTO and make sure work is covered.
► Work with the Director to complete staff Annual evaluation form.