Supervisor- Utilization Review

5 days ago

Greenville, United States Vidant Health Full time
Job Description

ECU Health

About ECU Health Medical Center

ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.

Position Summary

As a key leader within the Utilization Review Services, this role is responsible for assisting and supervising a multidisciplinary team with the day-to-day management of the Utilization Review Services and team members. This position will involve coordinating staff schedules to efficiently handle incoming referrals and phone call volumes and assist in the development of workflows, procedures, protocols, and best practices to achieve organizational goals and objectives. This position involves researching and resolving simple and complex patient/provider issues related to authorization, denials, clinical reviews and collaboration with physician advisors. This position will also conduct performance evaluations, counsel employees, and take disciplinary action as necessary in collaboration with the manager and director. The Supervisor will also participate in provision of service delivery during a portion of the time and assist with overall operations of the service. This position is a hybrid onsite/virtual role and will involve travel within the ECU Health service area.

Responsibilities
  • Manage team responsible for completing utilization management programs, processes, and tasks.
  • Edit, maintain, and implement policies and procedures that meet applicable regulatory requirements and business needs.
  • Implement and facilitate curriculum and ongoing training in collaboration with education specialists.
  • Maintain daily case management statistics and reporting.
  • Research and manage team member and patient complaints.
Minimum Requirements
  • Bachelor of Science in Nursing is required.
  • Master of Science in Nursing is preferred.
  • Two or more years' experience in Utilization Review required.
  • Experience with evidence based clinical guidelines including MCG (Miliman) and/or InterQual preferred.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

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