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Managed Care Compliance Administrator

Athens AdministratorsLegal & Compliance
Hiring from
United States
Work type
Remote
Posted
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ATHENS POSITION DETAILS
Position Title:
Managed Care Compliance Administrator
Department:
Managed Care – Orange, CA
Reports To:
Cost Containment Director
FLSA Status:
Exempt
Job Grade:
13
ATHENS ADMINISTRATORS
Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today!
POSITION SUMMARY
Athens Administrators has an immediate need for a full-time Managed Care Compliance Administrator to support our Athens Managed Care department and can be located remotely if technical requirements are met and the employee resides in a state Athens operates in. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is 9am to 5pm PST regardless of time zone.
The Compliance Administrator ensures that the processes and procedures of the Managed Care Unit meet the overall quality expectations of the company, customers, and regulations. This includes quality and compliance audits, training, data analysis, and process improvement.
Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:
  • Develop and maintain Athens UR plan and best practices.
  • Monitor and evaluate all aspects of the day-to-day utilization review and nurse case management operations
  • Create department best practices, policy and procedure and workflows that are in compliance with the DWC standards
  • Responsible for overall workflow of managed care services, incorporating the strategies of cost containment, appropriate utilization of services and case management in a cooperative effort with external and internal parties
  • Provide technical support to Utilization Review (UR) coordinators and Nurse Case Managers (NCM) to ensure the efficient operation and profitability of department
  • Responsible for the ongoing training, supervision and evaluation of professional staff performing Utilization Review (UR) and Nurse Case Management (NCM) services, verifying nursing licenses, ensuring that CEU’s are obtained, assist clinical staff with review process, create and maintain training materials
  • Develop and recommend corrective and preventative actions in collaboration with the Quality Assurance Specialist
  • Coordinate audits as needed
  • Work closely with the Managed Care Supervisor to develop and monitor key performance indicators
  • Appropriately communicate organization information through department meetings, one-on-one meetings, appropriate email, and regular interpersonal communication
  • Responsible for Athens Managed Care URAC accreditation
  • Support Managed Care Supervisor and Managed Care Director in identifying and developing internal opportunities to work with Worker’s Compensation Claims staff to educate them on AMC services and drive Managed Care preferred vendor referrals
  • Responsible for creating all necessary forms, letters and templates to be contained within the system
  • Identify unique and efficient approaches to conducting the core processes of AMC that will produce outcomes that are superior within the industry
The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.
  • High School Diploma or equivalent (GED) required for all positions
    • AA/AS or BA/BS preferred but not required
  • 5 years of utilization review, quality assurance, case management or workers’ compensation experience required
  • Must be fully versed in CA, AZ and TX state workers’ compensation laws and practices. Additional states preferred but not required
  • RN or LVN license preferred but not required
  • Effectively influence people to achieve unit and organizational objectives
  • Excellent interpersonal and communication (written and oral) skills, including the ability to convey technical details
  • Ability to develop and maintain effective relationships with co-workers, vendors, management and other key stakeholders to achieve organizational goals
  • Self-directed and able to independently evaluate, determine priorities and manage projects with a high level of attention to detail
  • Ability to meet multiple demands and deadlines
  • Exercise independent judgment and analytic ability in solving complex and sensitive problems.
  • Ability to leverage technology for self and staff to improve efficiency within department
  • Mathematical calculating and analytical skills
  • Excellent organizational skills and ability to multi-task
  • Ability to type quickly, accurately and for prolonged periods
  • Advanced proficiency in Microsoft Office Suite
    • Ability to learn additional computer programs
  • Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues and make appropriate recommendations and solutions for resolution
  • Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
  • Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
  • Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner
  • Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor.
  • Athens’ operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.
  • Valid driver’s license and availability for travel including overnight
APPLY WITH US
We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at http://www.athensadmin.com/careers/job-openings Feel free to include a cover letter if you’d like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdf.
This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.
Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.
THANK YOU!
We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don’t forget to check out our website at www.athensadmin.com as well as our LinkedIn, Glassdoor, and Facebook pages!
Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://www.athensadmin.com/careers/why-work-here

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