Grounded by a compelling mission, core values, and compassion for people, CDPHP and its family of companies offer a strong foundation for a rewarding career. Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, quality, innovation, and community, and its corporate culture supports those values wholeheartedly. CDPHP is committed to fostering a culture of belonging and takes a wholistic approach to diversity, equity, and inclusion. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.

The Team Lead will serve as key technical support and provide guidance and direction to the Clinical Support Specialists (CSS). This role will be the initial level of escalation for issue resolution for all complaints related to CSS and will direct CSS resources in terms of assignments and priorities. The Team Lead will assist with monitoring daily inventory, assignment of queues, reports and projects. The Team Lead will research all system issues related to CSS responsibilities and provide timely and comprehensive resolution.

The Team Lead will also track and trend issues and will make recommendations within the department in regard to process improvements. The Team Lead will work with the Supervisor and Content Management to update workflow documentation related to CSS. This role will support the Quality Assurance team with quality review and Enterprise Training with training related to CSS as necessary. The Team Lead will also provide back up to the CSS position based on business needs. This role will perform testing for new products, system upgrades and other configuration enhancements as they relate to CSS. This role will not be responsible for formal employee corrective action or performance review processes but will be critical in assisting the Supervisor to assess these areas.

The Team Lead is required to successfully apply problem solving and time management methodology, balance multiple tasks, and adhere to all related CSS state and federal regulations and guidelines.

Qualifications:

• A minimum of two (2) years, experience in a health insurance related discipline required.

• Associates degree required; 2 years relevant experience may be substituted for degree

• 3-5 years utilization management experience is preferred.

• Experience in managed care health plan benefits and be able to carefully assess medical information required.

• Knowledge of how to strategically allocate resources to ensure all service level objectives are met is preferred.

• Strong PC skills and Microsoft Windows and working knowledge with Authorization processing and procedural review required.

• Demonstrated ability to determine, analyze and solve problems related to processing CSS requests and related tasks.

• Demonstrated knowledge of Utilization policy, regulatory guidelines and all systems used for the CSS tasks.

• Ability to successfully apply problem solving and time management methodology and balance multiple tasks as business needs arise required.

• Excellent verbal and written skills are required.

• Experience working with CDPHP internal departments and outside customers is preferred.

• Strong attention to detail and ability to meet established quality and production standards while maintaining department turnaround timeframes required.

• Ability to interpret all CDPHP’s health plan contract language, riders, schedules, policies and procedures with adherence to department turnaround timeframes to insure regulatory compliance required.

• Working knowledge of all lines of business required.

CDPHP salary ranges are designed to be competitive with room for professional and financial growth. Individual compensation is based on several factors unique to each candidate, such as work experience, qualifications, and skills. In addition to cash compensation, CDPHP employees may be eligible for an incentive payment, a discretionary cash reward based on employee and company performance. Some roles may also be eligible for overtime pay.

CDPHP compensation packages go far beyond just salary. The company offers a comprehensive total rewards package that includes award-winning health care coverage, health care dollars, a generous paid time off allowance, employee assistance programs, flexible work environment, and much more. Learn about all CDPHP employee benefits at https://www.cdphp.com/about-us/jobs/benefits.

As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices on the basis of race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status.

CDPHP and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRx Services, LLC.