Medical Management - Supervisor Complex Utilization Management & Population Health Management

About the Role

Responsible for supervising and coordinating daily workflow and leadership of staff. Activities include developing operating procedures and managing personnel and resources.

Responsibilities

• Serves as a resource to the department staff by providing technical direction and resolving workflow problems or improvement opportunities within the department.
• Oversees the PHM team, supporting the development and implementation of care coordination, chronic disease management, and complex case management initiatives.
• Ensures regulatory requirements are met.
• Assesses individual workload and staffing patterns.
• Selects, assigns, and evaluates personnel, and recommends or initiates associated personnel actions.
• Takes caseload as needed to assist with staffing needs.
• Ensure authorization timeframes and regulatory requirements are met.
• Interviews, hires, trains, and reviews all eligibility personnel in addition to problem-solving and disciplinary actions.
• Participates in analysis of current policies and procedures and in the development of new or updated standard operating procedures and workflows.
• Attends departmental, interdepartmental, and facility meetings as needed.
• Performs other duties as assigned.

Qualifications

• Ability to plan, organize, schedule, and effect procedural changes.
• Ability to effectively lead, direct and supervise others.
• Ability to reason logically and to use good judgment when interpreting materials or situations.
• Ability to work quickly and accurately with quantitative information.
• Ability to organize time effectively and set priorities.
• Possess strong written and oral communication skills.
• Proficient in Microsoft applications.
• Knowledge of managed care and benefit plans.

Education/Experience

• Graduate from accredited School of Nursing.
• Current, active, unrestricted license to practice as Registered nurse (RN) in the State of Oklahoma.
• At least three years of clinical nursing experience in an acute care setting.
• 2 years of management experience preferred.

CommunityCare is an equal opportunity at-will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation, or national origin.