Manager, Care Management
Company: GEHA, Inc.
Location: Lees Summit
Posted on: January 12, 2021
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Job Description:
Summary Manages Medical Management Department and is responsible
for developing, modifying and implementing policies and procedures
within area of responsibility. Work group may have multiple types
of work being performed within the team so types of supervision
required is unique and personalized for each person with separate
projects/work being performed.Duties -- Work is planned in the
mid-range time horizon and is focused on establishing policy and
procedures for own work group or for other work groups as it
relates to responsibility.-- Responsible for employee selection,
performance and disciplinary decisions and may help with lower
level management hiring decisions.-- Makes decisions on work
processes and priorities for--Medical Management Team. Project
success/Work decisions measured on major project milestone.--
Establishes, and is accountable for, functional policies, processes
and objectives for department.-- Work includes influencing other
department management on issues where guidelines or general
understanding of company positioning already exists (e.g.,
negotiating with vendors, standard contact with outside
professionals or dealing with regulatory agencies on routine
matters)-- May negotiate with vendors on contract terms.-- Manage a
group who has unique projects that are not similar in nature and
supervision requires more personalization of guidance and goals for
each team member.Job Requirements:Education Requirements Requires a
Bachelor's degree in Nursing (120 credit hours) from an accredited
college/university. Additional relevant experience may be
considered in lieu of education. Current Registered Nurse Licensure
in Missouri or Kansas. Experience Requirements-- Requires three -
five years of managerial experience along with experience in the
discipline to be managed.-- Requires strong analytic and
problem-solving capabilities and the ability to identify solutions
and recommendations that effectively address business and control
needs along with how to train and guide others in this area.--
Requires the ability to multi-task effectively, responding to
changing business priorities and deadlines.-- Requires the ability
to work collaboratively with team members across multiple divisions
and departments.-- Requires a proven record of meeting commitments
and achieving goals through the encouragement, guidance and
influencing of others.-- Requires a self-starter personality.--
Requires highly effective verbal, written and interpersonal
communication skills.-- Requires flexibility and willingness to
work with a wide range of personalities on a variety of projects
while prioritizing effectively.-- Requires working knowledge of
Microsoft Office applications.Preferred Qualifications-- Master's
Degree in Nursing, Health Administration/Public Health,
Biostatistics-- Experience in Healthcare Quality or Utilization
Management-- Experience participating in prior-authorization in a
health system-- Experience in customer satisfaction principles--
Familiarity/experience with accreditation by NCQA, URAC and/or
AAAHC-- Familiarity or experience with clinical policy
interpretation and use of evidence-based resources-- Familiarity
with CPT and ICD-10 codingGEHA is an Equal Opportunity Employer.
GEHA will not discriminate against employees or applicants because
they have inquired about, discussed, or disclosed their
compensation or the compensation of another employee or applicant.
Our company's corporate headquarters is located in Lee's Summit
near Douglas Rd and I-470 with a total of five locations in the
Kansas City metropolitan area.
Keywords: GEHA, Inc., Lee's Summit , Manager, Care Management, Executive , Lees Summit, Missouri
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