Utilization Management (UM) Account Manager (Remote U.S.)

Company Description

CNSI and Kepro are now Acentra Health!  Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company, to actively engage in problem-solving, and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Job Description

Acentra seeks a Utilization Management Account Manager to join our growing team.

Job Summary:

The Utilization Management Account Manager will:

• Build strong relationships with customers’ senior management and account management staff.
• Develop a business partnership that promotes opportunities for growth and revenue while supporting the customer’s growth objectives.
• Optimize service to customers by identifying their needs and providing solutions within the scope of contracted services.
• Provide high-level internal communications within Acentra Health regarding clients and their vendor partners.

Job Responsibilities:

• Develop and strengthen relationships at the account management and senior management levels of key clients. Identify current and future service requirements by establishing personal rapport with key individuals who understand service requirements.
• Serve as a subject matter expert to customers by providing high-level product and service information. Demonstrate the impact of Acentra Health’s services for cost reductions and operations improvements. Manage contract and scope of work to ensure proper services are provided and avoid non-reimbursed services. Up-sell more services to existing traditional customers as well as to re-sell customers and partners.
• Establish and regularly update a strategic plan for each assigned account. Components of the plan include a schedule of deliverables with time frames, identified goals, customer relationship enhancements, and revenue growth.
• Provide training to the client for online reports and is the first contact for troubleshooting login issues related to the reports.
• Facilitate client communication and follow-ups to resolve outstanding issues and questions, and connects Operations, Finance, and Clinical areas to support client management.
• Communicate with staff regarding changes to services assigned to the contract.
• Serve as the main point of contact for clients related to policy changes, report requests, system changes and requests, etc.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

Qualifications

Required Qualifications/Experience:

• Active, unrestricted Registered Nurse (RN) license or a compact state license.
• Bachelor’s Degree or equivalent directly applicable experience in nursing, healthcare administration, or related area.
• Previous project or account management experience with a health plan.

Preferred Qualifications/Experience:

• 3+ years of utilization review experience.
• Previous experience managing account relations or serving as a liaison to customers.

Knowledge, Skills, Abilities:

• Excellent verbal and written communication skills.
• Current working knowledge of utilization management, case management, and managed care.
• Customer-focused, results-oriented, and capable of building and maintaining relationships with internal and external customers. 
• Organizational skills, ability to plan and prioritize multiple assignments.
• Current InterQual and Milliman criteria knowledge.
• Skill in examining and re-examining operations and procedures, formulating policy, and developing and implementing new strategies and procedures.
• Knowledge of the U.S. healthcare industry.
• Experience in using systems that support Utilization and Case Management processing.
• Demonstrated expertise in managing differing customer needs.
• Understanding of Utilization Review Accreditation Committee (URAC) standards and processes.
• Ability to participate as a team member, fostering collaborative decision-making among leadership, committees, teams, or work groups of diverse composition.
• Computer proficiency in Microsoft Office applications and other software progra