Remote Utilization Management Jobs in Boston, MA

100% REMOTE

JOB SUMMARY

Oversee and ensure the overall profitability of the regional operations center. This includes but is not limited to reaching and exceeding financial & referral goals, properly managing staffing efficiencies throughout the team, managing performance expectations & improvements for existing staff. Present management with regular reporting on any topic requested by the management team.

Dane Street's success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results.

MAJOR DUTIES & RESPONSIBILITIES

Driving Revenue Growth

• The Operations Manager drives revenue growth by delivering excellent Customer service.
• This includes meeting scheduling best practices and turnaround time requirements.
• Ensuring the timely delivery of high quality reports.

• Managing client inquiries in a timely manner.

Optimizing Physician cost

• Ensuring that client invoices adhere to the agreed upon fee schedule.
• Overseeing the proper selection of physicians. 
• Specifically ensuring that the team selects the most appropriate physician based on the claimant's location, the required specialty, and the most appropriately priced physician based on the client's fee schedule.

• Building relationships with key physicians to ensure panel retention.

  Manage Staff Performance and capacity

• Monitor key performance metrics of individual Customer Service Representatives (CSR) and Quality Assurance (QA) Specialists.
• Ensure the team meets or exceeds 85% of output goals for scheduling and Quality Assurance targets.
• Responsible for hiring new staff members based on increased referral volume and/or the addition of new clients.
• Conducts performance evaluations that are timely and constructive.
• Handles discipline and termination of employees as needed and in accordance with company policy.
• Responsible for the overall production, performance, and quality of the assigned region.  
• Plans and organizes daily activities related to production and operations.
• Measures productivity by analyzing performance data, financial data, and activity reports.
• Coordinates with other support departments such as human resources, finance, and IT and BA to ensure successful production operations.
• Determines labor needs to meet production goals.

Requirements

EDUCATION/CREDENTIALS:

• An Associate's Degree or Bachelor's Degree is preferred.
• RN / LPN License is required.

JOB RELEVANT EXPERIENCE:

• Business experience in a healthcare and/or insurance setting is preferred.
• Business experience in a Worker's Compensation and/or Auto insurance setting is preferred.
• Utilization Review experience is required.

JOB RELATED SKILLS/COMPETENCIES:

• Present exceptional communication skills with a clear understanding of company business lines.
• The ability to apply critical thinking, manage time efficiently and meet specific deadlines. Computer literacy and typing skills are essential.

WORK FROM HOME TECHNICAL REQUIREMENTS:

• Supply and support their own internet services.
• Maintaining an uninterrupted internet connection is a requirement of all work from home position.

Beginning compensation will depend on several factors including the candidate's experience, education, and specific skills. In addition to the base salary, we offer a comprehensive benefits package including health insurance, retirement plans, and performance bonuses.

Our Commitment:

We are committed to providing fair and competitive compensation that reflects each employee's contributions and performance. We value diversity and strive to create an inclusive environment for all employees.

Compensation Range: $75,000 - $93,750 USD

Benefits

Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace. 

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.