Job Openings Utilization Management Technician

About the job Utilization Management Technician

Its Time For A Change

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of Beckers 150 Great Places to Work in Healthcare in 2016 and 2017, and one of the 50 Great Places to Work in 2017 by Washingtonian, and our CEO was number one on Glassdoors 2015 Highest-Rated CEOs for Small and Medium Companies. If you're looking for a place where your work can be personally and professionally rewarding, don't just join a company with a mission. Join a mission with a company behind it.

Position Summary: 

  • The Supervisor, Utilization Management Technicians, is responsible for support of intake coordinators utilization management process including verification of eligibility, benefits, and coverage, recording demographic information for precertification requests, maintaining the Utilization Review database, generating approval and denial letters, answering phones, and general administrative support.
  • The Supervisor, Utilization Management Technicians, assists with day-to-day staff oversight duties including, but not limited to: work assignments, staff scheduling, process management, staff education, auditing, and performance appraisals.
  • May act as the utilization management program expert for a client, business line, or product related to Utilization Management Technician functions. Other duties may include, but are not limited to, clinical and operational meeting attendance, day-to-day oversight of work streams, and reporting analysis and action development.

Essential Functions:

  • Collaborates with physicians and other providers to facilitate provision of services throughout the health care continuum. Participates in ongoing development of policies and procedures/work instructions for medical management. Identifies and refer quality issues to the Director, Medical Management Provides administrative leadership to front line utilization management technician staff.
  • Implements established quality and performance standards for all aspects of the medical management program as demonstrated by compliance with Federal, State and accreditation requirements.
  • Works with utilization management staff to ensure that day to day utilization management activities are carried out in accordance with established policies and procedures.
  • Assists with the development of utilization management workflows based on established policies. Serves as the point of escalation for non-clinical issues from the front line staff.
  • Oversees day to day utilization management technician activities.
  • Assists with case management and disease management referral activity as directed by clinical utilization management staff.
  • In conjunction with the Manager of Utilization Management, maintains appropriate staffing ratios and team assignments based on volumes.
  • Performs and oversees intake authorization creation and phone support to ensure turnaround times and processing times are met.
  • Conducts audits and quality reviews of staff and reports results to the Manager of Utilization Management.
  • Oversees the day to day activities related to onboarding of new utilization management staff.
  • Performs daily audits to identify any trends or early identification of learning needs. Provides assistance with emergency and other escalated calls that may affect consumer safety.
  • Makes recommendations to the Manager and Director of Utilization Management regarding hiring and termination of staff.
  • Provides coaching and mentoring to staff in targeted areas as required.
  • Serves a subject matter expert to both internal and external entities on utilization management processes and systems.
  • Performs other duties as required.

Education and Experience:

  • High School Diploma or equivalent required
  • Minimum of 2 (two) years of call center experience with medical management activities in a managed care environment.
  • Minimum of 1-year data entry experience with medical management activities in a managed care environment.
  • Previous supervisory or above experience preferred.
  • Experience in a health care environment and familiarity with ICD-10 and CPT coding and/or medical terminology.
  • Knowledge of managed care principles, HMO and Risk Contracting arrangements.
  • Microsoft Office Suite preferred. Strong interpersonal, oral and written communication skills.
  • Possess basic computer skills