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Supervisor, Specialty Therapy Rehabilitative Service

Company: Centene
Location: Omaha
Posted on: December 4, 2019

Job Description:

Supervisor, Specialty Therapy Rehabilitative Service Position Purpose: Perform duties to supervise the day to day operations of the utilization management function; communicate with departmental and plan administrative staff to facilitate daily operations of the Utilization Management functions. - Oversee the workflow and day-to-day operations of the utilization management functions including supervising staff. - Ensure compliance with established referral, pre-certification and authorization policies, procedures and processes by staff. - Ensure compliance with established initial and concurrent review, utilization management, referral, pre-certification and authorization policies, procedures and processes. - Ensure compliance with plan's emergency management policies, procedures and processes by acting as liaison with other business units. - Facilitate on-going communication between provider relations, utilization management staff, provider trainer and contracted providers. - Assist with the implementation of policies and procedures regarding utilization management functions. - Maintain compliance with federal and state regulations and contractual agreements. - Provide oversight to denials and appeals function. - Monitor the effectiveness of existing procedures and outreach/intervention efforts. - Ensure appropriate medical necessity review at all locations. - Coordinate physician's review for adverse determination. - Ensure appropriate education and interventions are conducted for members defined to be at risk. - Monitor data to address trends or potential quality improvement opportunities including provider issues, service gaps, member needs. - Assist in the recruiting, hiring and training of utilization management staff as needed - Ensure HIPAA compliance. Education/Experience: Master's degree in a Specialty Therapies discipline (Speech, Occupational, or Physical Therapy), with National and/or State-Level Clinical Licensure. 5+ years of specialty therapy and/or utilization management experience. Thorough knowledge of a specialized or technical field such as case and/or utilization management involving knowledge plus the application of basic theory. Working knowledge of utilization review procedures, and familiarity with educational services. Previous experience as a lead in a functional area or managing cross functional teams on large scale projects. License/Certification: Current Certification/Licensure in Speech - Language Pathology, Occupational Therapy, or Physical Therapy in the State of Practice. For Nebraska Total Care Only: Master's Degree preferred but not required. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Clinical & Nursing USA-Nebraska-Omaha Nebraska Total Care Full-time

Keywords: Centene, Omaha , Supervisor, Specialty Therapy Rehabilitative Service, Healthcare , Omaha, Nebraska

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