Remote Manager Ancillary Services (RN) – Pennsylvania

Why Choose Jefferson Health Plans?

We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.

While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.

Perks of JHP and why you will love it here:

• Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing
• Flextime and Work-at-Home Options
• Benefits & Wellness Program including generous Time Off
• Impact on the communities we service

We are seeking a talented and enthusiastic Manager Ancillary Services to join our team!

General Description:

The Manager of Ancillary Services is responsible for the supervision of Durable Medical Equipment and Ancillary Services units: Oversees DME Coordinators and Ancillary Case Managers and works collaboratively with all areas within Utilization Management. In addition, the Manager will collaborate with the VP of Utilization Management in the coordination of clinical staff for new and on-going programs and projects.

As the Manager Ancillary Services, your daily duties may include:

• Manage employees to meet and exceed service requirements and objectives
• Recruit, develop, motivate and retain high caliber team members of nurse/social work case managers
• Coach and lead team to continuously improve operational performance and identify opportunities for efficiencies.
• Monitor HP Connect (portal) authorizations and functionality as it interfaces with CCMS
• Maintain a positive work environment that supports motivation and team work
• Responsible for the continual assessment of staff functionality to enhance team skills and capabilities
• Manage expenses while meeting operational, financial and service requirements
• Manage daily operations of Ancillary Services unit, including denial audits, staff audits, timesheets, time-off requests, staff meetings and ensuring timely actions and interventions, assisting in data analysis and reporting of outcomes.
• Leads monthly staff meetings supported by agenda and meeting minutes.
• Collaborate with and assist Directors, Vice President and SR and Medical Directors in the development, design, and implementation of new programs
• Work collaboratively with VP of Utilization Management to assure compliance of regulatory requirements and reporting.
• Assist in maintaining documentation of program activities for external and internal initiatives to assure compliance with regulatory agencies.
• Assist in NCQA Survey preparation
• Work with Contracting Department to ensure appropriate number of vendors in network for DME and Ancillary Services.
• Monitor and trend utilization of all Ancillary services , especially E1399 coding by vendors
• Review and maintain clinical criteria with Medical Directors for DME and chronic diseases
• Develop policies and procedures pertaining to pre certification of Ancillary Services.
• Participate in multidisciplinary/ Medical Director group rounds weekly with UM, DM and QM teams
• Participate in Clinical Quality Committee, Utilization Management Committee and Service Quality Committee.
• Participate in any adhoc committees as required.

Qualifications

• Registered Nurse licensed Pennsylvania with 3-5 years managed care experience with a minimum of 2 years in a management position.
• Public health or clinical experience preferred must have knowledge of HMO delivery systems.

Skills, We Value:

• Working knowledge of PC based applications such as Word, Access, Excel, and current Care Management system (CCMS).
• Familiarity with data and statistical analysis, knowledge of NCQA standards and overall utilization review function.
• Knowledge of Interqual criteria.
• Excellent organizational, time management, team building and verbal and written communication and interpersonal skills.

Job Type: Full-time

Pay: From $95,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid holidays
• Paid time off
• Referral program
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• Remote

Location:

• Pennsylvania (Required)

Work Location: Remote