Job Information
Magellan Health Services Manager, Clinical Correspondence and Policy in United States
Responsible for the management of the clinical correspondence and policy team in the development, approval, and production of all correspondence. Acts as the clinical liaison to the Compliance Department.
Develops and customizes correspondence according to regulatory requirements and contractual requirements including alignment with Compliance Department policies and procedures.
Provides oversight of the use of appropriate correspondence and review requests for new or modifications to existing correspondence templates.
Clinical correspondence liaison to Compliance Department.
Oversees clinical correspondence for all products in collaboration with Compliance Department.
Reviews and manages correspondence and clinical policy submissions under our UR licensure submissions.
Updates clinical correspondence templates as needed to ensure they meet the minimum standards for National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Employee Retirement Income Security Act of 1974 (ERISA), Centers for Medicare and Medicaid Services (CMS), and Company Policy across product lines and business segments.
Develops and maintains policies and procedures under the purview of the Correspondence Department, develops new policies for new or existing business, as assigned.
Researches state regulatory requirements for clinical correspondence and policies using online technology and research tools.
Develops and implements best practices related to the timely and consistent generation of clinical correspondence.
Consults with internal departments to support the letter generation process.
Develops and deploys q uality and quantitative metrics to demonstrate performance.
F osters a culture of continuous improvement and positive change, and uses data/metrics to improve process and procedure.
Identifies and drives improvement opportunities, along with prevention and controls for any errors found.
Provides leadership on all implementations, including client facing documentation and management of the overall timeline and deliverables.
Special projects as assigned.
Other Job Requirements
Responsibilities
5+ years of healthcare industry experience.
3+ years of experience with authorization correspondence, ensuring compliance with state/federal contractual requirements.
Supervisory experience with strong interpersonal skills; comfortable communicating and presenting to all levels of an organization.
Strong consultation, organizational, tracking and follow-up skills.
Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product.
Possesses excellent verbal and written communication skills.
Knowledge of legislative/oversight bodies [e.g., National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Employee Retirement Income Security Act of 1974 (ERISA), Centers for Medicare and Medicaid Services (CMS)].
This position requires a solid understanding of Magellan's products and workflows in relation to policies and standards.
Results and deadline driven.
Working knowledge of Microsoft Office Product Suite, specifically Word and Excel.
Willing and able to quickly learn new software and systems as needed.
General Job Information
Title
Manager, Clinical Correspondence and Policy
Grade
25
Work Experience - Required
Healthcare
Work Experience - Preferred
Education - Required
Bachelor's - Nursing, Master's - Behavioral Health
Education - Preferred
License and Certifications - Required
LCSW - Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
LSSBB - Lean Six Sigma Black Belt Certification - Enterprise, LSSGB - Lean Six Sigma Green Belt Certification - Enterprise, PMP - Project Management Professional - Enterprise
Salary Range
Salary Minimum:
$64,285
Salary Maximum:
$102,855
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.
Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.
Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here (https://www.magellanhealth.com/media/760295/mg-federal-contractors-applicant-english.pdf) .
Warning: Employment Scam
It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health. “Interviews” are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office.
Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit.
If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911