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Lumeris Supervisor, UM Operations (Non-Clinical) in St. Louis, Missouri

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Position:

Supervisor, UM Operations (Non-Clinical)

Position Summary:

The Supervisor, UM Operations manages the non-clinical Utilization Management (UM) staff in the Medical Management Department, which includes Medical Service Representatives (MSR) and UM administrative assistants. Non-clinical UM staff help administer the following in conjunction with clinical staff: PCP referral requests, coverage requests for health care services requiring prior authorization or notification, coordination with hospitals and PCP offices on inpatient notifications, Medicare Part C reporting, monitoring programs for regulatory compliance, pended medical claims, and health risk assessments.

Job Description:

Primary Responsibilities

  • Monitor all staff needs, including training requirements, quality and production.

  • Work with Director of Learning and Development to create department production development plan.

  • Review all departmental processes and identify efficiencies, gaps, and process improvements. Develop plan to improve efficiencies, bridge gaps, and improve processes. Create SOP’s to support all processes.

  • Review and manage departmental budget.

  • Allocate expenses for all invoicing requirements to support the department.

  • Responsible for day to day operations and supervision of the UM Non-Clinical team in accordance with administrative and departmental policies and procedures

  • Plan and lead quarterly staff meetings to review previous quarter’s production, quality, FAQ’s, and efficiencies.

  • Assist with CMS audits and client interactions

  • Provide counsel on performance issues

Qualifications

  • Associates degree or equivalent years of related experience

  • 3+ years of supervisory experience

  • Experience in Utilization Management in a Medicare managed care environment strongly preferred

  • Excellent interpersonal, oral and written communication

  • Strong problem solving and issue resolution skills

  • Ability to effectively present information to the team, cross functioning departments, clients and upper management

  • Ability to lead/manage others, successful management experience in the Healthcare field, prefer Medicare experience especially with Federal Regulations

  • Ability to work independently, handle multiple assignments, establish priorities, and demonstrate high level time management skills

  • Proficiency in Microsoft Office including Outlook, Work, Excel, Notebook and PowerPoint.

  • Knowledge with Facets, SharePoint and Knowledge Lake a plus

  • Ability to multi-task and self-motivate

  • Knowledge of medical terminology

Working Conditions

  • While performing the duties of this job, the employee works in normal office working conditions.

Disclaimer

  • The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities demand and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.

Location:

St. Louis, MO

Time Type:

Full time

Join Our Growing Team!

Lumeris is a value-based care managed services operator for health systems and providers seeking extraordinary clinical and financial outcomes. Lumeris aligns providers and payers across populations with technologies, processes, behaviors and information to achieve high-quality, cost-effective care with satisfied consumers — and engaged physicians.

Lumeris with Essence Healthcare, its inaugural client and learning laboratory with more than 60,000 Medicare members in Missouri and Illinois, has averaged a CMS rating of 4.5 Stars for the last ten years and produced the highest consumer and physician satisfaction scores in the industry along with significantly better clinical outcomes and lower costs. For more information, go to www.lumeris.com.

Why Join Lumeris?

At Lumeris, you will be part of team that is focused on solving the nation’s healthcare problem, and you will be able to contribute to our purpose. Our environment is fast-paced, change-oriented and focused on growth and employee engagement. At Lumeris, we know that talent is best utilized when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents.

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