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

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.

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