UM Intake Call Center Manager - Emblem Health

• Responsible for the direct supervision and oversight of the intake team and its strategic goal of ensuring appropriate/timely
access of member benefits.
• Supporting members of the managed long term care interdisciplinary care team with responsibility for problem solving the
execution of the non-clinical aspects of a participant's care and ensuring continuous process improvement.
• Responsible for planning, analyzing, documenting, implementing and overseeing the daily operation of the call center

Principal Accountabilities

• Responsible for the execution of efficient departmental processes designed to manage the UM Intake call center,
which includes compliance with all internal and external call center relates service levels, as well as appropriate
member/provider medical benefit access.
• Responsible for the supervision of the non-clinical staff intake call center team, ensuring the timely and appropriate
execution of daily call center volume/inventory.
• Develop, monitor, and communicate performance expectations and plans for all direct reports; conduct performance
reviews; provide feedback on a regular basis; assist with resolution of employee performance issues.
• Coach and mentor supervisors to ensure understanding of utilization management concepts and effectively apply the
concepts to managing members' health care needs.
• Ensure that staff adhere to the proper entry and maintenance of documentation in the Medical Management and
Service Cloud platforms meeting defined timeframes and performance standards, including the communication of
decisions and important benefit information to providers in accordance with applicable federal and state regulations,
and NCQA and business standards.
• Maintain an environment of quality improvement through continuous evaluation of processes and policies. Identify
and recommend new technologies and process efficiencies.
• Track and report statistics on call intake activities, process measures (e.g. timeliness), quality results, and other
measures that affect departmental objectives.
• Interact with various departments throughout the organization and contribute to the resolution of interdepartmental
issues. Lead and develop team to quickly assess and diagnose root causes to problem areas.
• Ensure compliance with State, Federal and NCQA requirements related to utilization management case-set up
activities.
• Actively participate on assigned committees and projects.
• Perform other duties as assigned.

Education, Training, Licenses, Certifications

• Bachelor's degree in Healthcare, business or communications.

Relevant Work Experience, Knowledge, Skills, and Abilities

• 5 - 8 years of related work experience, preferably in a customer service call center.
• 5 + years of managed care experience, preferably in a supervisory or managerial role.
• Additional years of experience or specialized training/experience may be considered in lieu of educational requirements.
• Prior supervisory experience.
• Strong interpersonal skills
• Knowledge of care management regulations and tactics.
• Strong oral and written communication and interpersonal skills.
• Strong organizational skills.
• Strong knowledge of Microsoft Office products including Word, Excel, and Access.

Additional Information

• Requisition ID: 1000000440