Alaska Native Tribal Health Consortium
Director of Utilization Management
Alaska Native Tribal Health Consortium, Anchorage, Alaska, United States, 99507
The Alaska Native Tribal Health Consortium is a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska. In partnership with the more than 171,000 Alaska Native and American Indian people that we serve and the Tribal health organizations of the Alaska Tribal Health System, ANTHC provides world-class health services, which include comprehensive medical services at the Alaska Native Medical Center, wellness programs, disease research and prevention, rural provider training and rural water and sanitation systems construction.
ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska’s second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation’s largest state.
Our vision: Alaska Native people are the healthiest people in the world.
ANTHC offers a competitive and comprehensive Benefits Package for all Benefit Eligible Employees, which includes:
Medical Insurance
provided through the Federal Employee Health Benefits Program as a Tribal Employee, with over 20 plans and tiers.
Cost-Share Dental and Vision Insurances
Discounted Pet Insurance
Retirement Contributions
with Pre-Tax or Roth options into a 403(b).
Retirement Match and Discretionary . ANTHC matches up to 5%, with a 3% discretionary contribution after one year of employment into a 401(a).
Paid Time Off
starts immediately, earning up to 6 hours per pay period, with paid time off accruals increasing based on years of service.
Twelve Paid Holidays
Paid Parental Leave
or miscarriage/stillbirth eligibility after six months of employment.
Basic Short/Long Term Disability premiums, Accidental Death and Dismemberment (AD&D) Insurance, and Basic Life Insurance
are covered 100% by ANTHC, with additional options for Short-Term Disability Buy-Up Coverage and Voluntary Life for yourself and your family members.
Flexible Spending Accounts
for Healthcare and Dependent Care.
Ancillary Cash Benefits
for accident, hospital indemnity, and critical illness.
On-Site Child Care Facility
with expert-designed classrooms for early child development and preschool.
Employee Assistance Program
with support for grief, financial counseling, mental/emotional health, and discounted legal advice.
Tuition Discounts
for you and your eligible dependents at Alaska Pacific University.
On-Site Training Courses and Professional Development Opportunities.
License and certification reimbursements and occupational insurance for medical staff.
Gym Access
to Alaska Pacific University includes a salt water pool, rock climbing, workout gym, and steep discounts for outdoor equipment rentals.
Emergency Travel Assistance
Education Assistance or Education leave eligibility
Discount program for travel, gym memberships, amusement parks, and more.
or contact Recruitment directly at HRRecruiting@anthc.org.
Alaska Native Tribal Health Consortium has a hiring preference for qualified Alaska Native and American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.
Summary:
Under limited supervision, directs one or more specialty nursing and non-nursing areas developing and implementing strategic processes to improve productivity and efficiencies of insurance verification, prior authorization, and utilization review at Alaska Native Medical Center.
Responsibilities:
Supports continuous clinical improvement activities at ANMC by analyzing department processes for efficiency and effectiveness to ensure facilitation of optimum reimbursement while complying with government and private insurance reimbursement policies. Develops department goals. Develops processes to monitor accuracy, timeliness, and outcomes of insurance verifications, prior-authorizations, and clinical reviews. Monitors concurrent reviews to assure that care meets national standards, is timely, and cost effective. Assures compliance with all regulatory and accreditation requirements. Coordinates with other ANMC department Directors to prepare the annual Utilization Review Plan in compliance with CoP 482.30. Presents analysis and reports of significant utilization trends, patterns and impact to resources to the Utilization Review Committee, Administration and Senior Management as appropriate or requested. Through effective coordination of information, assures effective communication between ANMC departments. Consults with other Directors and providers to develop improved utilization of services and resources. Serves as a liaison between ANMC departments, various Regional organizations and state and Federal agencies; serves on committees, task forces and other groups as appropriate. Manages, develops and coaches staff, building on individual strengths and assists in setting professional goals. Develops orientation and ongoing department training to expand staff knowledge, confidence, proficiency in duties and efficiency in productivity. Implements corrective actions and conducts performance evaluations. Compiles and maintains records, reports and statistical information for evaluation and planning. Provides leadership, direction and guidance on professional responsibilities and technical skills. Meets regularly with staff to resolve workload and technical issues. Assures staff remains certified and licensed in their fields of expertise as required by regulation or ANMC policy. Recommends staffing allocations and equipment requirements. Coordinates ancillary staff support for the Unit. Maintains appropriate Unit performance records and prepares summary reports as required. Performs other duties as assigned.
KNOWLEDGE and SKILLS:
Ability to prioritize and work with minimal supervision.
Highly organized with detail and results orientation.
Excellent communication skills, both written and verbal.
Sensitivity to and willingness to interact with persons of various social, cultural, economic and educational backgrounds.
Proficiency with software and/or equipment.
Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines.
Strong written and verbal communication skills.
Strong interpersonal skills. Ability to work with people with a variety of background and educational levels.
Ability to work independently and as part of a team.
Good judgment, problem-solving, and decision-making skills.
Demonstrated commitment to working collaboratively as well as possessing the skills to lead, influence, and motivate others.
Ability to work in a fast-paced, expanding organization.
MINIMUM EDUCATION QUALIFICATION:
Bachelors degree in related healthcare field required. Progressively responsible professional work-related experience, education, or training may be substituted on a year-for-year basis for college education.
MINIMUM EXPERIENCE QUALIFICATION:
Non-supervisory – Ten (10) years of responsible utilization management experienceANDSupervisory – Five (5) years involving professional employee supervision.
MINIMUM CERTIFICATION QUALIFICATION:
N/A
PREFERRED EDUCATION QUALIFICATION:
N/A
PREFERRED EXPERIENCE QUALIFICATION:
N/A
PREFERRED CERTIFICATION QUALIFICATION:
N/A
ADDITIONAL REQUIREMENTS:
May be required to work outside the traditional work schedule.
May be called out to work off-shift in emergency situations.
According to the needs of the organization, some incumbents in this job class may be required to obtain specific technical certifications and programming language skills.
#J-18808-Ljbffr
ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska’s second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation’s largest state.
Our vision: Alaska Native people are the healthiest people in the world.
ANTHC offers a competitive and comprehensive Benefits Package for all Benefit Eligible Employees, which includes:
Medical Insurance
provided through the Federal Employee Health Benefits Program as a Tribal Employee, with over 20 plans and tiers.
Cost-Share Dental and Vision Insurances
Discounted Pet Insurance
Retirement Contributions
with Pre-Tax or Roth options into a 403(b).
Retirement Match and Discretionary . ANTHC matches up to 5%, with a 3% discretionary contribution after one year of employment into a 401(a).
Paid Time Off
starts immediately, earning up to 6 hours per pay period, with paid time off accruals increasing based on years of service.
Twelve Paid Holidays
Paid Parental Leave
or miscarriage/stillbirth eligibility after six months of employment.
Basic Short/Long Term Disability premiums, Accidental Death and Dismemberment (AD&D) Insurance, and Basic Life Insurance
are covered 100% by ANTHC, with additional options for Short-Term Disability Buy-Up Coverage and Voluntary Life for yourself and your family members.
Flexible Spending Accounts
for Healthcare and Dependent Care.
Ancillary Cash Benefits
for accident, hospital indemnity, and critical illness.
On-Site Child Care Facility
with expert-designed classrooms for early child development and preschool.
Employee Assistance Program
with support for grief, financial counseling, mental/emotional health, and discounted legal advice.
Tuition Discounts
for you and your eligible dependents at Alaska Pacific University.
On-Site Training Courses and Professional Development Opportunities.
License and certification reimbursements and occupational insurance for medical staff.
Gym Access
to Alaska Pacific University includes a salt water pool, rock climbing, workout gym, and steep discounts for outdoor equipment rentals.
Emergency Travel Assistance
Education Assistance or Education leave eligibility
Discount program for travel, gym memberships, amusement parks, and more.
or contact Recruitment directly at HRRecruiting@anthc.org.
Alaska Native Tribal Health Consortium has a hiring preference for qualified Alaska Native and American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.
Summary:
Under limited supervision, directs one or more specialty nursing and non-nursing areas developing and implementing strategic processes to improve productivity and efficiencies of insurance verification, prior authorization, and utilization review at Alaska Native Medical Center.
Responsibilities:
Supports continuous clinical improvement activities at ANMC by analyzing department processes for efficiency and effectiveness to ensure facilitation of optimum reimbursement while complying with government and private insurance reimbursement policies. Develops department goals. Develops processes to monitor accuracy, timeliness, and outcomes of insurance verifications, prior-authorizations, and clinical reviews. Monitors concurrent reviews to assure that care meets national standards, is timely, and cost effective. Assures compliance with all regulatory and accreditation requirements. Coordinates with other ANMC department Directors to prepare the annual Utilization Review Plan in compliance with CoP 482.30. Presents analysis and reports of significant utilization trends, patterns and impact to resources to the Utilization Review Committee, Administration and Senior Management as appropriate or requested. Through effective coordination of information, assures effective communication between ANMC departments. Consults with other Directors and providers to develop improved utilization of services and resources. Serves as a liaison between ANMC departments, various Regional organizations and state and Federal agencies; serves on committees, task forces and other groups as appropriate. Manages, develops and coaches staff, building on individual strengths and assists in setting professional goals. Develops orientation and ongoing department training to expand staff knowledge, confidence, proficiency in duties and efficiency in productivity. Implements corrective actions and conducts performance evaluations. Compiles and maintains records, reports and statistical information for evaluation and planning. Provides leadership, direction and guidance on professional responsibilities and technical skills. Meets regularly with staff to resolve workload and technical issues. Assures staff remains certified and licensed in their fields of expertise as required by regulation or ANMC policy. Recommends staffing allocations and equipment requirements. Coordinates ancillary staff support for the Unit. Maintains appropriate Unit performance records and prepares summary reports as required. Performs other duties as assigned.
KNOWLEDGE and SKILLS:
Ability to prioritize and work with minimal supervision.
Highly organized with detail and results orientation.
Excellent communication skills, both written and verbal.
Sensitivity to and willingness to interact with persons of various social, cultural, economic and educational backgrounds.
Proficiency with software and/or equipment.
Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines.
Strong written and verbal communication skills.
Strong interpersonal skills. Ability to work with people with a variety of background and educational levels.
Ability to work independently and as part of a team.
Good judgment, problem-solving, and decision-making skills.
Demonstrated commitment to working collaboratively as well as possessing the skills to lead, influence, and motivate others.
Ability to work in a fast-paced, expanding organization.
MINIMUM EDUCATION QUALIFICATION:
Bachelors degree in related healthcare field required. Progressively responsible professional work-related experience, education, or training may be substituted on a year-for-year basis for college education.
MINIMUM EXPERIENCE QUALIFICATION:
Non-supervisory – Ten (10) years of responsible utilization management experienceANDSupervisory – Five (5) years involving professional employee supervision.
MINIMUM CERTIFICATION QUALIFICATION:
N/A
PREFERRED EDUCATION QUALIFICATION:
N/A
PREFERRED EXPERIENCE QUALIFICATION:
N/A
PREFERRED CERTIFICATION QUALIFICATION:
N/A
ADDITIONAL REQUIREMENTS:
May be required to work outside the traditional work schedule.
May be called out to work off-shift in emergency situations.
According to the needs of the organization, some incumbents in this job class may be required to obtain specific technical certifications and programming language skills.
#J-18808-Ljbffr