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Utilization Management Supervisor
2 months ago
Position Overview:
The role involves overseeing the daily operations of the utilization management team. This position is crucial for providing leadership, support, and resources to ensure the team operates effectively and meets departmental objectives.
Key Responsibilities:
- Deliver daily guidance, direction, and resources to the utilization management staff.
- Manage supervisory tasks including timecard oversight and staff scheduling to align with business needs.
- Offer constructive performance feedback and conduct annual evaluations for team members.
- Engage in the recruitment, interviewing, and onboarding processes for new employees.
- Maintain active involvement in provider reporting and adjust assignments to align with business requirements.
- Document and manage patient-specific records in the designated computer systems.
- Participate in committees and workgroups to support the strategic objectives of the organization.
- Facilitate meetings with community provider partners as part of the utilization management process.
- Foster positive relationships with business partners to enhance member care and provider satisfaction.
- Review and recommend improvements to departmental policies and procedures for operational efficiency.
- Investigate provider issues to ensure effective resolutions and exceptional customer service.
- Conduct audits of medical records for accuracy and process improvement.
- Evaluate care appropriateness based on established criteria and regulations.
- Engage in special projects and assignments as necessary.
Qualifications:
Education and Experience:
Associate or Bachelor's degree in nursing is required. A Registered Nurse (RN) with 3-5 years of experience, including supervisory roles, and at least one year in managed care or case management is preferred.
Licenses and Certifications:
A current California RN license is mandatory. Supervisory responsibilities will include both RN and LVN staff. Case Management certification is preferred.
Skills:
Strong understanding of clinical nursing requirements and utilization management programs is essential. Proficiency in using automated systems for data access is required. The ability to work independently in a fast-paced environment while managing multiple priorities is crucial.
Performance Competencies:
Knowledge of relevant regulations and the ability to build effective working relationships are key. Strong organizational skills and computer literacy are necessary for success in this role.
Work Environment:
This position requires frequent use of a computer and the ability to manage interruptions effectively. Some travel may be required.
Compensation:
The hiring range for this position is $136,000 to $177,185.82.
Disclaimer:
The responsibilities and qualifications outlined in this description are representative and not exhaustive. The employer reserves the right to modify this job description as needed.
