Anticipated End Date:

2024-09-17

Position Title:

Manager I Utilization Management

Job Description:

Simply Healthcare Plans, Inc. is a proud member of Elevance Health's family of brands. We are a licensed health maintenance organization with health plans for people enrolled in Medicaid and/or Medicare programs in Florida.

Manager I Utilization Management 

Location: 11430 NW 20th ST, STE 300, Miami, FL 33172 or FL-TAMPA, 5411 SKY CENTER DR.

This position will take part in Elevance Health's hybrid workforce strategy which includes virtual work and 1-2 days physically in office per week.  Our Ideal candidate will live within a 50-mile radius and a 1-hour commute to our Elevance Health major office (PulsePoint) in Miami or Tampa, FL. Elevance Health supports a hybrid workplace model with PulsePoint sites used for collaboration, community, and connection.

The Manager I Utilization Management is responsible for the daily management of the department.

How You Will Make an Impact

Primary duties may include, but are not limited to:

• Supervises workflow and performance of associates.
• Assists in coordination and development of UM quality initiatives.
• Participates in strategic planning and budget processes.
• Ensures compliance with departmental policies and procedures.
• Works in conjunction with other UM staff to improve service quality initiatives, develop audit tools, and meet NMIS and other quality standards.
• Provides quality control services such as call monitoring.
• Develops and implements associate training.
• Performs audits to monitor efficiency and compliance with policies.
• Prepares reports.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Minimum Requirements:

• Requires HS diploma or equivalent and a minimum of 4 years operational experience in a progressively complex customer service or call center; or any combination of education and experience which would provide an equivalent background.  
• For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Preferred Skills, Capabilities and Experiences:

• RN or BSN preferred.  
• Experience in Long Term Care and Utilization Management Process preferred.
• Bilingual (English and Spanish) preferred.

Job Level:

Manager

Workshift:

1st Shift (United States of America)

Job Family:

CUS > Service Operations

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.