Manager, Utilization Management, Healthcare Operations
Who are we?
Versant Health is one of the nation’s leading administrators of managed vision care, serving millions of our clients’ members nationwide. We are driven by our mission to help members enjoy the wonders of sight through healthy eyes and vision.
As a Versant Health associate, you can enjoy a comprehensive Total Rewards package, which includes health and dental insurance, tuition reimbursement, 401(k) with company match, pet insurance, no-cost-to-you vision insurance for you and your qualified dependents. We are also invested in your success. There are many opportunities for advancement and development throughout all stages of your career with us.
See how you can make a difference with the support of strong leadership and a team environment.
See Everything, Be Anything.
What are we looking for?
The Manager, Healthcare Operations for the Utilization Management department is responsible for on-going review of business processes and implementing changes to improve efficiency and service. The Manager, Healthcare Operations of Utilization Management will be responsible to oversee utilization management staff charged with promoting quality member outcomes, optimizing member benefits, and promoting effective/efficient use of resources. This position has responsibility to ensure prior authorization timeliness for all lines of business following federal, individual state, and contractual regulatory requirements. Analysis and review of reports is required for this position. Activities of the department include prior authorization review, and appeal support. The incumbent will work in conjunction with Claims Operations, Client Management, Network Development & Operations, Information Technology, Compliance, and Reporting to support and continue to improve service delivery and quality.
Where you will have an impact
- Ensures adherence to departmental policy, medical policy, and member benefits in providing services that are medically appropriate, high quality, and cost effective
- Handles all incoming utilization management requests in accordance with all statutory, regulatory, accreditation and contractual requirements
- Ensures that utilization management cases are completed within the required timeliness requirements for Medicare, Medicaid, and Commercial lines of business
- Analyzes data and information to identify business opportunities and implements change to improve departmental processes
- Collaborate with key-stakeholders to improve cost-effectiveness across all platforms
- Represents the Utilization Management department for client audits and case file reviews
- Participates in client meetings to ensure that all client contractual performance guarantees and regulatory state requirements are met and adhered to
- Supports member and provider appeals process as required
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
- Develops and provides training and education to direct reports to support client requirements and regulatory standards governing the applicable line of business
- Requires rotation to weekends to provide managerial oversight to staff working on the weekend
- Partners with other members of the Utilization Management Leadership team to support operations and business requirements to meet changing business needs and improve efficiency and service.
- Supports companywide strategic initiatives
- Manages all incoming utilization management requests in accordance with all statutory, regulatory, accreditation and contractual requirements
What’s necessary to do the job?
- Bachelor’s degree in the field of Business Administration, Information Systems, Computer Science, or a similar degree. Consideration of work experience in lieu of bachelor’s degree.
- Minimum of 3 years of managed care experience with a healthcare payer organization
- Intermediate level with various software programs including Microsoft Office Suite (Excel, Word, PowerPoint, Visio, and Outlook)
- Proven experience with government programs such as Medicare and Medicaid supporting utilization / medical management business operations
- Experience working on multiple projects concurrently
- Strong analytical and problem-solving skills
HIPAA & Security Requirements
All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.
Versant Health will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.
Versant Health is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at Versant Health without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.
The wage range for applicants for this position is [$95,000.00 to $105,000.00].
All incentives and benefits are subject to the applicable plan terms.
