Supervisor of Utilization Management

Job Summary

The Supervisor provides day-to-day operational support for Transitional Care and Complex Care Management team, focusing on coordinating work schedules, ensuring policy compliance, and monitoring the quality of care delivered to members. This role supports the implementation of processes designed to improve health outcomes, reduce healthcare utilization costs, and facilitate effective care transitions for complex populations. The Supervisor works closely with the Director/Manager, Shared Services, Medical Center, and other stakeholders to ensure a seamless continuum of care across inpatient, ambulatory, and community-based settings. As a liaison between staff and management, the Supervisor facilitates communication and supports efficient team operations. Additionally, the Supervisor assists with performance evaluations and handles certain disciplinary actions, collaborating with the Manager to uphold a high standard of service.

Duties And Responsibilities

• Team Supervision and Support
• Supervise utilization team members, including Transitional Care Managers.
• Aid in staff development and ensure adherence to care management standards, including person-centered care planning and documentation protocols.
• Conduct case audits, one-on-one coaching/training to maintain quality and compliance with regulatory standards.
• Support team members with caseload management to ensure timely documentation and adherence to organizational and health plan requirements.
• Interview, hire, and host regular 1:1 meetings and performance reviews.
• Interdisciplinary Coordination
• Facilitate coordination with community organizations, primary care providers, and specialists to address members' chronic care needs and facilitate smooth transitions of care.
• Partner with inpatient case management for collaborative discharge planning.
• Aid in hosting and documenting interdisciplinary care team (ICT) meetings to support effective member outcomes.
• Performance Monitoring and Improvement
• Utilize data and reporting to monitor team performance and identify opportunities for improvement in health outcomes and member satisfaction.
• Work closely with the manager to implement performance improvement plans for staff as needed.
• Member Engagement and Case Management
• Support as a resource and support for team members in managing complex cases, addressing members' medical, behavioral, and socioeconomic needs through best practices and therapeutic approaches.
• Stakeholder Relationship Support
• Support the manager in maintaining relationships with payors, community organizations, and facility leadership to address barriers such as housing, food security, and financial instability.
• Onboarding, Training, and Staff Engagement
• Aid in onboarding, training, and development for new team members.
• Play a key role in Chapters 3 and 4 onboarding for new hires.
• Support team meetings and contribute to building team morale and productivity.

Minimum Qualifications

• Licensure and Education
• Minimum License: Current, active, and unrestricted license in a health or human services discipline that, within its scope of practice, allows you to conduct an assessment independently (e.g. RN, SW).
• Minimum Certifications: Qualified with CCM Credentials or obtain within 24 months of hire. CMGT-BC, CCTM, C-SWCM, C-ASWCM, ACM or FAACM will be considered.
• BLS/CPR required.
• Experience
• 5-7 years of experience in care management, with at least 2-3 years in a supervisory role, ideally in Value-Based Care, Utilization Management, or Complex Care Management.
• Familiarity with complex populations (Medicaid, Medicare, dual-eligible individuals) and experience with medically complex, trauma-experienced, and socially vulnerable individuals.
• Technical Skills
• Proficiency with Microsoft Office Suite and electronic health record (EHR) systems.
• Strong analytical skills to support performance monitoring and improvement initiatives.
• Interpersonal And Communication Skills
• Strong verbal and written communication skills for effective interaction with team members, members, families, and interdisciplinary teams.
• Ability to promote teamwork, manage change effectively, and make sound judgments.