DE031312 - Health Clinical Services Assoc Manager

This job is with Accenture, an inclusive employer and a member of myGwork – the largest global platform for the LGBTQ+ business community. Please do not contact the recruiter directly. ---ONLY THOSE APPLICANTS WHO ALREADY HAVE THE RIGHT TO LIVE AND WORK IN THIS COUNTRY ARE ELIGIBLE TO APPLY FOR THIS ROLE---POSITION TITLE: Health Clinical Services Assoc ManagerWORK SETUP: RTOResponsibilities:

• Oversees staff and Team Leads in either Utilization Management (UM) and/or appeals whose primary duties may include:O Conducts pre-service, concurrent/continue stay and retrospective service requests received via telephone, facsimile, portal, email and/or writingO Perform out of network reviews O Determine the appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contractsO Outbound calls to the provider may be required to gather additional information as needed to perform clinical review
• Provides leadership, oversight, guidance and mentor staff and team leads with making clinical decisions, which have major day-to-day impact in area of responsibility, and may influence direction of other areas.
• Allocates resources and responsibilities across team to deliver business results and develop team members.
• Manages and ensures consistent application of human resource processes including career/professional development support, coaching and performance management within area of responsibility.
• Initiates and promotes continuous improvement programs across sphere of influence.
• Responsible for maintaining contractual, regulatory and accreditation compliance by knowing, understanding, correctly interpreting, and accurately applying requirements, regulations, and standards. Reports suspected or confirmed issues timely as the situation warrants to the CompliOTHERSProject Shift Schedule: Night ShiftProject Rest Day: WeekendsProject/Team Location: Gateway Tower 2
  
  

• At least 7 years relevant experience and 5 years supervisory- (Supervisory experience can be a combination of both BPO and clinical)
• Holds current and unrestricted US Registered Nurse license. No state specific RN licensure required.
• BPO experience should be any account (Health account experience is only a plus, but not required)
• Excellent written and verbal communication skills in English
• Strong proficiency in Microsoft Excel, Word and PPT
• Strong customer service focus
• Ability to empathize
• Prioritizing customer needs
• Listening, patience & action oriented
• Good understanding of phone etiquette]]>