Manager Ancillary Services - JHP

Number of Positions In Requisition

1

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.

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.

• 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.

• 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
  - State of Pennsylvania
• LSW
  - Licensed Social Worker
  - State of Pennsylvania

• Public health or clinical experience preferred

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.

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.

Workday Day (United States of America)

Regular

Health Partners Plans, Inc.

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally…