Supervisor, Medical Management

About the role

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

Responsibilities

• Oversee daily operations and activities performed by non-clinical staff, including Prior Authorization, Hospital Notification, and Concurrent Review support, to ensure the provision of appropriate utilization of services and efficient and quality service to members and providers.
• Demonstrate oversight of the authorization process, hospital notification and census management.
• Complete quality review and auditing to ensure compliance with all regulatory and compliance standards.
• Support ongoing department process improvements through the PDSA practice by timely communication and education to the team.
• Ensure staff success by timely communication of job expectations and monitoring of goal progress by coaching and counseling employees; initiating, coordinating, and enforcing systems, policies, and procedures.
• Maintain staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities.
• Build effective professional relationships with providers and other internal and external partners by using excellent verbal and written communication skills, developing trust, meeting timelines, respecting cultural differences, using active listening skills, and maintaining confidentiality.
• Promote compliance with and adhere to all regulatory and quality standards including but not limited to: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and accreditation bodies’ standards such as the National Committee for Quality Assurance (NCQA) as it relates to Medical Management's activities.
• Supervise/Manage Others (i.e. hires, performance reviews, corrective action, etc.).

Qualifications

• Associate's Degree or equivalent experience
• 2-3 years of related experience in a Medicare Advantage Health Plan Utilization Management
• At least 1 year of leadership experience
• Knowledge of the field's policies, procedures, and practices
• Leadership - Basic skills to develop others
• Problem Solving - Basic problem-solving skills
• Communication - Good communication and interpersonal skills

Benefits

Your Qualifications Associate's Degree or equivalent experience
2-3 years of related experience in a Medicare Advantage Health Plan Utilization Management
At least 1 year of leadership experience
Knowledge of the field's policies, procedures, and practices
Leadership - Basic skills to develop others
Problem Solving - Basic problem-solving skills
Communication - Good communication and interpersonal skills

Pay

Base salary range: $70,304 to $84,143 per year

Schedule

Work Mode: Mostly Remote