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UCM Data Project Coordinator - Utilization Review

Maumee, Ohio
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Description

At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA – the National Committee for Quality Assurance – for our Ohio HMO, Elite and Advantage products. We’re also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.

 

Summary

The Paramount UCM team is recruiting for a UCM Data Project Coordinator. The Data Project Coordinator  will  assume responsibility and oversight for the coordination and design of long and short-term Utilization departmental projects and process improvement initiatives as related to Plan goals and objectives. 

 

PRINCIPAL ACCOUNTABILITIES:

  • Coordinate utilization/case management responsibilities as related to new product development, enhancement, and implementation of new and/or upgraded software/applications.
  • Participate in the departmental Care Management and QI Workplan development and evaluation process. Continuous assessment of ROI on risk score efforts and reallocation of priorities/resources to improve risk scores and foster profit improvement. Assist in managing the relationship with selected risk adjustment software vendors, coordinate effort and evaluate ROI.
  • Prepare standard weekly, quarterly, monthly and/or annual reports to applicable employer groups and their representatives. Prepare ad-hoc weekly, quarterly, monthly and/or annual reports to applicable employer groups and their representatives.
  • Use in-house software packages to run existing queries in order to acquire group reporting data. Use in-house software packages to create new queries in order to acquire group reporting data.
  • Coordinate, facilitate, design, and secure data elements while participating in a liaison role to internal or external departments and customers including:  ODM, CMS, and other Utilization/Case Management data requirements.  Assist in any follow up related to UM departmental data outcomes. Develop and maintain dashboards that represent team goals and progress towards those goals.
  • Meet with and make presentations to leadership and internal teams.  Provide consultation on allocation of resources/most effective practices.  Engage others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Paramount’s success first. Mentor Group Reporting Interns and Analyst I.
  • Collaborate with departmental representatives to create or update procedures as required. Recommend and implement changes to current processes to improve customer service.
     

  • Education: Associates in Health Care Administration or related field.
  • Skills
    • Recent experience in public health, managed care or quality improvement environment required.
    • Strong background in data analysis and data management experience required.
    • Knowledge of health care delivery systems, managed care concepts, claims processing, medical terminology, medical billing, and CPT and HCPC’s Codes required.
    • Project Management and meeting facilitation skills preferred.
    • Demonstrated planning, organizational, analytical, ability to mobilize resources, and problem solving skills required, with the ability to handle multiple priorities and to work independently.
    • Demonstrated ability to exercise critical thinking with minimal supervision required.
    • Ability to travel throughout the State of Ohio as needed.
    • Excelled communication (oral, written & interpersonal) skills required.  Experience with all Microsoft Applications including spreadsheet design, word processing and Access database applications required.</li>
  • Years of Experience: Recent Experience in Public Health, Managed care, or quality improvement environment required.

 

 

PREFERRED QUALIFICATIONS

Education: Bachelor’s Degree in Health Care Administration or related field.

Years of Experience: 5+ years of relevant RN experience

License: Current Ohio and Michigan nursing license preferred

 

ADDITIONAL EXPERIENCE

  • Be able to understand directions and respond to inquiries; must have excellent interpersonal skills and ability to work with people at all levels of the organization.
  • Be able to move about business offices and between work stations.
  • Be fully proficient with Microsoft Office products including Word, Excel and Power Point.
  • Be able to occasionally move lightweight materials.

 

 

 

ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio.  For more information, please visit www.promedica.org/about-promedica

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org

Equal Opportunity Employer/Drug-Free Workplace

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