- Manage UM team performance to meet or exceed SLAs for turnaround times, decision timeliness, and quality benchmarks.
- Conduct one-on-ones, performance reviews, and coaching sessions to drive team accountability and professional development.
- Design and execute quality assurance and inter-rater reliability activities to ensure consistent application of PACE policies.
- Oversee staffing, workload distribution, and recruitment for the clinical team.
- Handle complex UM cases, concurrent reviews, and escalated provider disputes personally for 25% of the time.
- Utilize data analytics to monitor care patterns, cost drivers, and utilization efficiency to lead performance improvement initiatives.
- Partner with internal leadership and external PACE client stakeholders to ensure alignment on care strategies and reporting.
Quality AssuranceTeam managementData analytics