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Utilization Clinical Manager

Kepro

This is a Full-time position in Fort Collins, CO posted November 24, 2021.

Kepro seeks a Utilization Clinical Manager to oversee a team of supervisors and clinicians conducting the Utilization Review functions for Medicaid programs for the State of Wyoming.

The Clinical Manager will collaborate on and support all areas of Utilization Management as well as assist with training and management of assigned workloads to ensure compliance with performance (timeline and quality) standards.

The Clinical Manager coordinates with leadership on decisions and issues, and communicates with stakeholders regarding clinical matters.

Accountabilities

  • Oversee, coordinate, and monitor all Clinical team/assessor activities.
  • Directly manage all supervisors who manage teams of RN’s.
  • This role will coordinate with the Agency on UM decisions, issues, and communicate with providers and inpatient facilities regarding utilization review decisions and other clinical matters.
  • Ensure adequate staffing and contractual service levels are adhered to by implementing and monitoring clinical staff productivity and performance indicators.

    Maintain effective team member relations.

  • Lead team members in improving skills, creativity, and problem-solving.
  • Develop policies and procedures, interpretive guidelines and inter-rater reliability activities to ensure consistent application of assessments.
  • Develop communication and training methods to enhance skill set, define skill gaps and remediation efforts.
  • Represent the clinical department by participating on committees, task forces, work groups.
  • Handle escalated issues/concerns and identify opportunities for improvement.
  • Maintain professional relationships with provider community and external customers.
  • Provides reports of compliance and other activities.
  • Intermittent travel for quality assurance and other purposes.
  • Represent the Clinical team’s performance, goals, upcoming activities, risks and overall status at various internal and external venues, as requested.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

Qualifications

  • Bachelor’s degree in health and human services or medical field required, Master’s preferred.
  • Active Non-restricted, Wyoming RN license required.

Knowledge, Skills, Abilities

  • Demonstrated proficiency in MS Office applications.
  • Successful record leading clinical or health and human services professionals.
  • Ability to develop best practice policies and procedures and systems to support new work that meets performance expectations.
  • Ability to work collaboratively with other leadership team members to achieve department goals.
  • Ability to professionally respond to change and handle multiple and changing priorities with sometimes conflicting deadlines.

Experience

  • 5+ years of clinical experience required.
  • 5+ years staff/workload management experience required.
  • Experience with WY Medicaid programs, strongly preferred.
  • Expertise assessing individuals with disabilities and vulnerable populations preferred.