Manager, Utilization Review and Claims

Who We Are and Our Mission: MTM and MTM Transit are healthcare and transportation management companies whose mission is to collaborate with clients in developing innovative solutions for accessing healthcare, increasing independence, and connecting community resources in the most cost-effective manner. As the nation's most trusted partners in removing community barriers, we prioritize the wellbeing of the communities we serve through philanthropy. Nationwide, our diverse employee base is always willing to give back and contribute. As a Woman-Owned Business Enterprise (WBE) certified by the Women's Business Enterprise National Council, we are committed to maintaining and empowering a diverse workforce. Simply put, we are passionate about what we do and it shows. MTM has been recognized with numerous awards and accolades, including Mogul's Top 100 Innovators in Diversity & Inclusion (2017). The St. Louis Business Journal Healthiest Employers (2020), Best Places to Work (2019), Fastest-Growing Private Companies (2017), Top Family Owned Business (2016) and Top Five Largest Women-Owned Business (2020) What Will Your Job Look Like? The Manager, Utilization Review and Claims is responsible the daily management of regulatory compliance, quality control and timely processing of ambulance claims. This position will sit in Connecticut and is contingent upon contract award. What You’ll Do: Provide day-to-day oversight and monitoring to ensure business outcomes and goals are defined and met Develop, implement, review, and revise policies and procedures to guide care delivery Maintain staffing as required and provide guidance and support to all employees Coordinate scheduling of NEMT (non-emergent) transports as needed Conduct employee performance evaluations Ensure and monitor compliance with local, state and federal regulations Ensures required notification timelines are met Monitors and communicates any state regulation changes Ensure all program activities are being performed accurately and consistently to ensure the program’s ongoing contractual and institutional compliance Manage ongoing accreditation and quality management programs as required by client contract Plan and implement systems to provide ongoing monitoring of compliance with systems redesign when needed Follow all Client and MTM policies and procedures Training of staff on policies, procedures and client protocols Assist in reviewing and updating workflows, procedures, and correspondence Available to backup staff on inbound/outbound calls and adhere to identified phone compliance standards Provide excellent customer service What You’ll need: High school diploma or G.E.D. equivalent Minimum 5 years’ experience in a utilization management and/or clinical oversight position, or related role Minimum 3 years’ experience supervising a team Previous experience working with Medicaid and or Medicare programs Even better if you have... Bachelor of Social Work Intermediate computer skills in Microsoft applications, including Word, Excel, and Access Ability to type 30wpm Strong organizational skills Ability to manage and prioritize multiple tasks in a fast-paced environment Ability to handle confidential information in a professional manner Ability to make solid judgment calls Ability to handle escalated calls appropriately and professionally Strong communication skills Ability to relate and handle diverse members Ability to work independently and as part of a team Ability to maintain high level of confidentiality Regular attendance is required What’s in it for you: Health and Life Insurance Plans Dental and Vision Plans 401(k) with a company match Flexible Scheduling Paid Time Off and Holiday Pay Maternity/Paternity Leave Birthday Holiday Casual Dress Environment Tuition Reimbursement MTM Perks Discount Program Milestone Anniversary One Month Sabbatical Leadership Mentoring Opportunities Salary Range: Salary Min: $70K Salary Max: $85K This information reflects the base salary pay range for this job based on current national market data. Ranges may vary based on the job's location. We offer competitive pay that varies based on individual skills, experience, and other relevant factors. We encourage you to apply to positions that you are interested in and for which you believe you are qualified. To learn more, you are welcome to discuss with us as you move through the selection process. Equal Opportunity Employer: MTM is an equal opportunity employer. MTM considers qualified candidates with a criminal history in a manner consistent with the requirements of applicable local, State, and Federal law. If you are in need of accommodations, please contact MTM’s People & Culture. #MTM