Inpatient UM Supervisor

7 days ago


Los Angeles, California, United States MedPOINT Management Full time
Job Summary

We are seeking a highly skilled Inpatient UM Supervisor to join our team at MedPOINT Management. This role will oversee Inpatient UM clinical Members within their respective Team Centers, working closely with Health Plans, Facilities, and IPAs to ensure coordinated and continuous cost-effective quality healthcare is delivered to members.

Key Responsibilities
  • Oversee Inpatient Review and coordination of all clinical activities of Inpatient UM Teammates in collaboration with the CCC Manager and other key players within MPM and client partners.
  • Provide leadership and supervision of day-to-day inpatient UM functions for their clinical team members.
  • Oversee daily workload for nurses to assess and determine staffing needs, ensuring minimum productivity standards are met.
  • Assist in resolving any identified issues escalated by the Leads.
  • Serve as a resource for Inpatient UM regulations and processes to Internal and external team members.
  • Assist with the creation and implementation of standard operating procedures, job aids, policies, and procedures in alignment with department and organizational strategic priorities.
  • Identify network opportunities based on vendor and specialty gaps.
  • Provide oversight of concurrent and retrospective reviews for medical necessity using evidenced-based criteria.
  • Ensure inter-rater reliability audits are being conducted.
  • Refer members to appropriate internal and external programs.
  • Address and research cases escalated by DMHC for retrospective claims review.
  • Represent Inpatient UM Department in selected meetings.
  • Coach, evaluate, and provide annual performance evaluation feedback to Team Members.
  • Ensure the privacy and security of PHI (Protected Health Information).
Requirements
  • Possession of a valid RN/LVN license issued by the State of California required.
  • Possession of a valid State of California driver's license and automobile insurance.
  • Minimum 2 years leadership experience in a Managed Care setting.
  • Three years of Inpatient Management/Case Management in a healthcare delivery setting.
  • Working knowledge of case management philosophy/process/role, needs assessment, principles of utilization review/quality assurance, use of Milliman or other clinical decision support criteria, discharge planning, and reimbursement structures.
Skills and Abilities
  • Self-starter and a team player.
  • Strong analytical skills, critical thinking skills, time management, and problem-solving abilities.
  • High degree of patience, excellent communication, interpersonal, time management, and organizational skills.
  • Ability to read, analyze, and comprehend complex clinical data and its application to level of care criteria and discharge options.


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