Utilization Review and Quality Assurance Manager
Concentra is looking for talented professionals who will embrace and personify the Company values of:- A Healing Focus- A Selfless Heart- A Tireless ResolveSuccessful candidates will be those who exemplify the welcoming, respectful & skillful behaviors that support our Company focus on excellence in health, wellness, customer service and a passion for lifestyle change.JOB SUMMARY:Responsible for the administrative implementation and maintenance of Concentra Physician Reviews Quality Assurance, Vendor Management and Regulatory/Compliance Monitoring programs. Also assists in the expansion of the contracted physician network.Ensures the delivery of exceptional customer service by being a main point of contact for key clients by putting all customers (internal and external) first and displaying:- A healing focus- A selfless heart- A tireless resolveMAJOR DUTIES AND RESPONSIBILITIES:- Acts as main point of contact for clients to engage the business unit with regard to questions, issues and complaints. Coordinates customer survey process, analyze survey results, and summarize findings to Leadership Team.- Complaint and Issue Tracking: Log complaints and route to appropriate party for resolution. Track final resolution of complaints including being the conduit for reporting findings and resolution to clients when necessary. Summarize objective and statistical findings into report, and report out findings to Leadership Team on a regularly scheduled basis.- Coordinates the creation and administration of a regulatory and compliance monitoring process and measurement as well as a corrective action system. Analyze monthly results and summarize findings to Leadership Team. Additionally, develops and administers vendor payment validation reporting as a part of the Up-front vendor payment process.- Perform other duties as assigned:+ Back-up oversight of daily operations in the absence of the Director of Operations+ Recruit externally contracted physicians+ URAC accreditation preparation assistance+ New product development+ Misc. projectsSCOPE MEASURES:This position is a senior/lead staff professional requiring comprehensive knowledge of Utilization Review/Management practices and principles. This individual will have to effectively communicate with management and the National Medical Director regarding status and progress. While there are no direct management duties, this position is expected to provide back-up oversight of daily operations in the absence of the Director of Operations. In addition, this position will be working closely with key clients who bring millions of dollars of revenue to the company.JOB-RELATED SKILLS/COMPETENCIES:- Excellent interpersonal and communication skills.- Mature professional demeanor recognizing the need to assure confidentiality.- Comprehension of organizational policies, procedures and systems.- Ability to work efficiently, handling multiple tasks simultaneously.- Ability to develop alternative solutions to problems; comparing and analyzing data; preparing clear, concise and grammatically correct written reports, letters, memoranda and other documents.- Ability to independently plan, organize, prioritize, schedule, coordinate and make decisions relating to assigned tasks and responsibilities.- Ability to travel and work after normal business hours as required to fulfill the responsibilities of this position.- Well versed in Windows operating systems software including, but not limited to Word, Excel and preferably Access and PowerPointAnalysis and Critical Thinking- Problem Solving- Quantitative Analysis- Decision Making- Planning and OrganizingInterpersonal Effectiveness- Conflict Management- Delegation- Diversity AwarenessCommunication- Oral Communication- Written Communication- Active Listening- Giving FeedbackOrganizational Awareness- Political Acumen- Customer ServiceGroup Leadership- Group FacilitationWORKING CONDITIONS:Office setting working individuals who are remotely located.EDUCATION/CREDENTIALS:Bachelors degree in healthcare related field is preferred (appropriate experience can be substituted for education). LPN or RN preferred.JOB-RELATED EXPERIENCE:Three to five years experience in Workers Comp and/or Group Health Utilization Review/Management.