Job Description

Summary

The UMDO Supervisor’s primary responsibility is to oversee and strategize the day-to-day operations of UM Compliance and NOA Operations. The Supervisor will report directly to the Sr. Supervisor of UM Delegation Oversight.

Duties and Responsibilities: 

• Oversight of the effective, timely, and compliant support for all UM audits and requests for information from upstream business partners and ensure consistent accuracy, timeliness, and compliant submissions
• Accountable for the quality and continued improvement of NOA operations
• Oversee, monitor, and evaluate monthly NOA operation production and adjust workflows, as needed 
• Oversee and monitor the health plan letter template implementation process
• Monitor the data integrity and timeliness of all UM audit requests (pre- and post-audits)
• Develop and maintain monitoring/Quality Assurance (QA) methods and tools to self-identify and correct potential
• Support the UM team in developing root cause analysis and potential solutions to corrective action plans (CAPs) requested from auditors/clients
• Collaborate with UM leadership in developing necessary workflows and SOPs for improvement opportunities  
• Prepare corrective action plans and develop SMART goals on identified deficiencies to mitigate potential risk
• Accountable for staffing ratio 
• Oversee the team member’s user guide, training assessment, and implementation 
• Counsel team members appropriately and conduct formal disciplinary action, as needed
• Initiate and follow through with special projects
• Effectively communicate updates, trends, opportunities, and/or progress with their direct supervisor 
• Plan and conduct monthly team huddles, events, and team activities 
• Attend UM and Compliance meetings as required 
• Perform other duties as assigned

Minimum Job Requirements:

• BS/BA required, Master's Degree or Clinical Degree preferred
• 3+ years’ experience working in UM operations with a focus on compliance/operations
• Strong familiarity with UM, NCQA Standards, DMHC, DHCS, and CMS regulatory requirements
• Proficiency in Microsoft Office (Word, Excel, PowerPoint, Visio, OneNote)
• Ability to navigate EZ-CAP, Tableau, and Smartsheet

Skills and Abilities:

• Excellent written and verbal communication skills
• Ability to communicate with all levels of management and influence employees through strong communication and presentation skills 
• Excellent organizational skills with the ability to balance several priorities
• Strong interpersonal skills
• Ability to make sound judgments and act professionally under pressure

Salary Range:

• $85,000 – $95,000 annually

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