Job Information
Blue Cross Blue Shield of Michigan Manager - Utilization Management Medicare Post-Acute Care in Detroit, Michigan
Responsible for planning, organizing and managing an assigned business unit. Operate within broad objectives to ensure optimum utilization of resources; adapt business unit plans and priorities to address resource and operational challenges. Evaluate policies, procedures and business unit goals to make decisions and solve problems. * Manage activities of a department including, but not limited to planning, problem solving, staff development and communication. * Manage the evaluation of new and existing business processes to identify areas of opportunity and execute on business unit objectives, supporting continuous improvement. * Lead, direct, evaluate and develop the work of assigned employees. * Responsible for special projects, programs and initiatives to ensure successful delivery of business outcomes. * Provide effective and efficient solutions to complex business problems * Ensure that day to day business unit operations align with organizational objectives. "Qualifications" * Bachelor's Degree in a related field is required. Master's Degree in a related field is preferred. * Five (5) years of experience in a related field is required. * Previous experience leading projects and/or teams is required. * Ability to effectively lead, coach and develop team members. * Ability to work effectively in a team environment. * Strong organizational, planning, analytical, and problem-solving skills. * Working knowledge of corporate organizational structures, including functional responsibilities. * Strong verbal, written communication and interpersonal skills. * Ability to manage multiple priorities concurrently. * Ability to solve practical problems and deal with moving variables in situations with limited standardization and alignment. * Ability to interface and present to all levels of the organization. * Ability to build relationships and work collaboratively with cross-functional teams. Department Summary / Preferences: Position will be responsible for managing both clinical and non-clinical staff that support the MA Post Acute Care Prior Authorization Program. An understanding of care settings from Skilled nursing facilities, Long Term Acute Care Hospital, Inpatient Rehabilitaion, and transitional care in the home setting will be important. Ability to lead and develop a team is also important. Experience that is not required, but is considered in selection: - Managing case or patient volumes and assigning staff as needed - Experience using the following systems * CareAdvance * Content Manager * OneNote * SharePoint - Understanding patients with skilled care needs versus custodial care needs to support care decisions for PAC patients - Experience assessing and support home care needs - PAC or HHC clinical experience All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.