Supervisor Utilization Management

About the role

Cambia is seeking a Supervisor Utilization Management to join our team. This role is hybrid (3 days/week in office) and candidates must reside within commutable distance of one of our offices in Burlington, Renton, Spokane, Vancouver, Portland, Medford, Salt Lake City, Boise, Lewiston, or Fargo. The role is based in person in one of these locations.

Responsibilities

• Assigns and prioritizes work, sets goals, and coordinates daily activities of the team.
• Provides regular updates and communication to staff through 1:1 and team meetings.
• Makes sure individual and team results are completed in a timely manner, in accordance with department standards and procedures, and are in compliance with medical policy and medical necessity guidelines.
• Aids in developing productivity and quality standards.
• Conducts or participates in compliance audits and reports audit findings.
• Identifies and implements process improvements as needed.
• Acts as a resource for staff and others.
• Escalates issues appropriately and partners with other departments to resolve issues and remove barriers.
• Collaborates with physician advisors on complex case and coverage determination processes.
• Participates in the hiring process, provides ongoing coaching, employee development, and writes performance reviews.
• Develops and maintains desk reference guides on work procedures.
• Ensures new hires complete necessary training.
• Affirms training needs and plays an active role in staff development.
• Completes special projects as assigned and provides backup support to staff as needed.
• Maintains clinical competency and stays current on medical practices, procedures, and industry trends.
• May develop and present educational updates internally or to other departments.
• Sets ideas and opportunities for continuous improvement, determines which opportunities should be pursued, and implements improvements as appropriate.

Requirements

• Bachelor's degree in Nursing or related field
• 3 years of leadership experience
• 5 years of clinical experience or equivalent combination of education and experience
• License or certification in a state or territory of the United States in a health or human services-related field that allows conducting an assessment within the scope of practice of the discipline (e.g. medical vs. behavioral health)
• Current unrestricted Registered Nurse (RN) license in a state or territory of the United States

Skills and Attributes

• Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines.
• Ability to communicate effectively, verbally and in writing, including with members, employer or provider groups.
• Ability to effectively develop and lead a team (including employees who may be in multiple locations or work remotely).
• Demonstrated experience in recognizing problems and effectively resolving complex issues.
• Familiarity with health insurance industry trends and technology.
• Demonstrated competency related to clinical utilization management and care management practices.
• Knowledge of payment coding guidelines, as applicable (Payment Review only).
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.