McLaren Health Plan, recognized by Modern Health Care as one of the 100 Best Places to Work for four years in a row, is seeking a Supervisor for our Medical Management Team.
Responsible for providing supervision of staff (RN Case Mgrs, MA Intake Specialist and clerical staff) and function to meet organizational goals in utilization, disease, case and medical management. Ongoing monitoring of assigned department performance standards regarding timeliness, appropriateness, and cost effectiveness. Is the recognized resource of the department for problem solving, including research and implementation of sound clinical decision making. The primary focus for daily responsibilities includes utilization and case management process review and oversight for assigned products for all duties. Works diligently with staff to ensure the delivery of quality services at the most appropriate and cost effective setting. Assists where necessary or through project management those business ventures undertaken by the Company to ensure its profitable future.
REQUIRED QUALIFICATIONS •Current Valid RN License •Bachelor’s Degree in nursing or related field. An equivalent combination of relevant education and experience may be substituted for the educational requirement •Two (2) years experience in a supervisory role for a staff of five or more members, leading or assisting in all phases of effective supervision (ie. Recruitment, performance management, training) •Two (2) years experience in utilization review and/or case management •Two (2) years experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g. medical delivery, regulatory compliance, claims processing, membership/eligibility, risk arrangements, etc.)
To further our mission of enhancing the health status of the individuals and communities we serve, effective February 1, 2013,?McLaren Health Plan will no longer hire individuals who use tobacco or nicotine products in any form. Cotinine testing will be used to verify non-tobacco use. Individuals whose health screening results are verified positive for tobacco/nicotine use will be disqualified from employment, their job offer will be rescinded, and they will be disqualified from reapplying for employment for six (6) months from the date of the health screening.
Additional Salary Information: This position is eligible to participate in the leadership incentive program with an award of up to 5% of annual salary
McLaren Health Plan provides a range of health care coverage through its HMO, insurance company and Third Party Administrator. The plans include commercial HMO, Point of Service, High Deductible Health Plans, fully insured PPO and self-funded PPO. McLaren Health Plan is also proud to partner with the State of Michigan to provide health care services to Medicaid and Medicare Advantage recipients.M...cLaren Health Plan's Mission is to enhance our members' health status in the communities we serve by promoting: •Preventive care and well-being•Access to quality health services•Strong relationships with our members, providers, and employersMcLaren Health Plan has been recognized by Modern Health Care as one of the 100 Best Places to Work for four years in a row.