This position is responsible for providing oversight to the daily functions of the Utilization Management (UM) for the Medicaid and the Medicare beneficiaries. The Senior Manager of UM will assist and partner with the Director of Health Services, Vice President of Health Services and the Medical Directors in implementing the culture and work environment that promotes and inspires an active continuous improvement philosophy in regard to overseeing medical and utilization control program that safeguards against unnecessary or inappropriate use of services. The Senior Manager will have oversight for UM Managers and staff in all VPHP regions. Additional responsibilities include coordinating, conducting and documenting simple to complex Health Services projects and operational procedures and identification of process for utilization management.
Medical Management educates members and empowers them to become active participants in their coordinated health care plans. This team of knowledgeable professionals in their field provide services to include Utilization Review, Medical Outreach, Case Management, Disease Management, Credentialing, Social Work as well as Grievance and Appeals
MINIMUM EDUCATION REQUIRED
SPECIAL KNOWLEDGE AND/OR SKILLS
Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs. Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia.
We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE
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