Lead, Healthcare Services (Utilization Management) - Remote in FL

Job description

JOB DESCRIPTION: Must reside in Florida: Job Summary: Provides lead level clinical support to healthcare services team supporting one or more of the following functions: care management, utilization management, care transitions, long-term services and supports (LTSS), behavioral health, and other clinical programs, and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties: - Provides level support to healthcare services department staff - devising/implementing delegation assignment strategies, facilitating healthcare services processes and communicating/coordinating activities. - Resolves issues and complaints that arise in day-to-day healthcare services operations and communicates escalation issues to healthcare services leadership. - Assists in training of healthcare services staff according to department standards, policies and procedures. - Maintains a minimal caseload to ensure adherence to appropriate guidelines and provide assistance to staff who have...