Manager Ancillary Services - JHP

Health Partners Plans, Inc.; United States; On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Comprehensive benefits package

Tuition assistance

Job summary

Health Partners Plans, Inc. seeks a Manager of Ancillary Services to supervise the DME and Ancillary Services units and coordinate with Utilization Management. The role leads N, case managers and coordinators, aiming to improve operations and regulatory compliance across programs.

Responsibilities include staff leadership, program development, data reporting, and cross-functional collaboration with VP UM and medical directors to implement new initiatives.

Qualifications

• Specialized Diploma Registered Nurse licensed Pennsylvania; 3 years managed care experience with at least 2 years in a management position.
• Working knowledge of PC-based applications such as Word, Access, Excel, and CCMS.
• Familiarity with data and statistical analysis; knowledge of NCQA standards and utilization review.

Responsibilities

• Manage employees to meet and exceed service requirements and objectives.
• Recruit, develop, motivate and retain high-caliber nurse/social work case managers.
• Coach and lead team to improve operational performance and identify efficiencies.
• Monitor HP Connect authorizations and interface with CCMS.
• Collaborate with Directors, VP and Medical Directors on new programs; ensure regulatory compliance.

Skills

RN licensure

Managed care experience

Leadership experience

Interpersonal skills

Data and reporting

Education

RN - Licensed Registered Nurse_PA

LSW - Licensed Social Worker_PA

Tools

PC-based applications (Word, Access, Excel)

Job description

Number of Positions In Requisition 1 Job Details 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.

Job Description Summary

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.

Job Duties

• 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

Minimum Qualifications

• Specialized Diploma Registered Nurse licensed Pennsylvania 3 years managed care experience with a minimum of 2 years in a management position
• 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
• must have knowledge of HMO delivery systems
• RN - Licensed Registered Nurse_PA - State of Pennsylvania
• LSW - Licensed Social Worker - State of Pennsylvania

Preferred Qualifications

• Public health or clinical experience preferred

Additional Qualifications

Physical Demands Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer

This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift

Workday Day (United States of America) Worker Sub Type Regular Employee Entity Health Partners Plans, Inc.

Primary Location

Address 1101 Market, Philadelphia, Pennsylvania, United States of America Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years. Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance. For more benefits information, please click here

In keeping with Jefferson's Mission, We Improve Lives, it is our goal to recruit, retain, develop and reward highly-qualified employees. If you are enthusiastic, caring and dedicated to service excellence, we invite you to consider joining Jefferson. Jefferson encourages its employees to expand their knowledge and develop their careers through growth opportunities and continuing education. With a long standing history, Jefferson has been advancing the medical field from the heart of Center City Philadelphia for nearly 200 years. Our Mission, We Improve Lives, expands to every corner of the organization. From our weekly farmer’s market, to our new Jefferson Accelerator Zone for innovation, our employees’ passion for the community is evident by the daily gestures towards our patients, students and each other.