Managed Care Manager / Educator - Full Time in Lakeland, Florida at WATSON CLINIC LLP

Summary/Objective

The Managed Care Manager/Educator will work with the staff to ensure prompt, accurate and efficient processing of referrals and authorizations for the care of Clinic patients. The Manager will also gain a deep understanding of the departmental processes and procedures and assist in the training and coaching of team members.

Essential Functions

Coordinate and conduct all onboarding and ongoing training for new and existing MCRS team members. Educate the MCRS team on clinic policies, procedures, authorization and referral workflows while partnering with leadership to identify training needs, support cross-training, and develop the team. Keeps all training documents, processes, department education and clinical guidelines up to date. Tracks and implement approved educational updates related to payer changes.

Assist with the resolution of complex referral and authorization cases that require escalation and involve medical directors or Assistant Director level staff from a payer. Manager/Educator will also assist Patient Advocate with referral/authorization related issues.

Analyze various reports and perform data collection. Includes peer-to-peer requests and monthly denial reports, among others. Coordinate with associated departments to decrease denials rates and peer-to-peer requests.

Run productivity reports to perform analysis used in performance appraisals to focus on strengths, weaknesses and targets. This is integral for the setting of goals for each team member. Assist management in making decisions based upon data.

Works with Assistant Director to manage the annual performance review process and presents minor disciplinary actions and corrections to assigned MCRS. Performance of basic clerical duties and completion of assigned projects. All other MCRS duties as applicable.

Supervisory Responsibility

This position manages the MCRS team.

Work Environment & Physical Demands

Must be able to remain in a stationary position 50% of the time (seated at desk)

Constantly operates a computer and other office productivity machinery, such as a calculator, copier and computer printer.

Must be able to communicate with all levels of the organization and exchange accurate information.

Travel

Travel is limited to traversing between Clinic locations when necessary.

Required Education and Experience

Experience obtaining authorizations and referrals

Advanced proficiencies with Microsoft Office products, including Excel

Experience in an outpatient medical group

Understanding of managed care policies and processes