Manager, Medical Management

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare.

SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.

Job Description:

The Job

The Manager, Medical Management is responsible for overseeing the efficient and high-quality delivery of medical services to members and providers. This role involves monitoring service utilization, ensuring compliance with regulatory and accrediting standards, and supervising the daily activities of the Medical Management team. The Manager will play a crucial role in enhancing service delivery, optimizing resource utilization, and maintaining the highest standards of compliance and quality.

You Will

Service Delivery and Quality Assurance: Ensure the delivery of efficient and high-quality service to members and providers by overseeing and coordinating the activities of the Medical Management team. This includes addressing member and provider inquiries, resolving issues, and maintaining high standards of customer service.

Utilization Management: Monitor the utilization of medical services to optimize resource allocation and cost-effectiveness. This involves reviewing and analyzing data to identify trends, implementing strategies to manage service utilization, and ensuring that services are provided in a timely and appropriate manner.

Compliance and Regulatory Oversight: Supervise the daily activities of the Medical Management staff to ensure compliance with all regulatory and accrediting standards. This includes conducting regular audits, providing training on compliance policies, and maintaining up-to-date knowledge of relevant regulations and best practices.

Lead daily operations for non-clinical UM functions, including intake, fax triage, benefits review, and administrative processing.

Monitor SLAs, productivity, and quality metrics; implement workflow improvements to drive same day determinations and reduce provider abrasion.

Develop, coach, and mentor a team of supervisors; provide performance feedback and manage schedules/coverage to ensure operational readiness.

Collaborate cross-functionally with Claims, Network, TOC, Pharmacy, and Reporting to streamline processes and improve member and provider experience.

Assist in audit readiness and documentation for CMS, DHCS, ODAG/CDAG, and internal compliance monitoring.

Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)

We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

Actively support the achievement of SCAN's Vision and Goals.

Other duties as assigned.

Your Qualifications

Bachelor's Degree or equivalent experience required, preferred degrees Business, Healthcare Administration or similar.

3-5 years of related experience.

2-3 years of leadership experience.

Leadership- Lead and inspire teams to achieve.

Problem Solving- Good problem-solving skills.

Communication- Good communication and interpersonal skills.

Strong understanding of UM operations, authorization workflows, and regulatory requirements (CMS, DHCS, NCQA).

Change-management mindset with ability to support new processes, technology, and automation.

Strong Leadership and Supervisory Skills: Ability to effectively lead and manage a team, providing guidance, training, and support to ensure high performance and compliance with organizational standards.

Analytical and Problem-Solving Skills: Proficient in analyzing data and trends to make informed decisions, optimize resource utilization, and address service delivery issues efficiently.

Excellent Communication and Interpersonal Skills: Ability to communicate clearly and professionally with members, providers, and internal stakeholders, fostering strong relationships and ensuring effective collaboration.

Strong understanding of UM operations, authorization workflows, and regulatory requirements (CMS, DHCS, NCQA).

Change-management mindset with ability to support new processes, technology, and automation.

What's in it for you?

• Base salary range: $92,400 - $133,671 per year

• Remote position with work hours M-F 8am-5pm Pacific Time

• An annual employee bonus program

• Robust Wellness Program

• Generous paid-time-off (PTO)

• Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday

• Excellent 401(k) Retirement Saving Plan with employer match and contribution

• Robust employee recognition program

• Tuition reimbursement

• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)