Supervisor, Utilization Management

About the role

Integrates and coordinates utilization management, care coordination, discharge planning functions, and performance improvement activities for all care managers. Accountable for oversight of the department's designated team member caseloads, planning effectively to meet staffing needs, manage length of stay, promote efficient utilization of resources, and ensure that care meets evidence-based practice standards and regulatory/payor requirements.

Responsibilities

• Facilitates collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement.
• Supervises staff with all care management processes, including LOS, throughput, patient flow, and denials and appeals follow-up.
• Applies process improvement methodologies in evaluating team members' documentation.
• Ensures that multidisciplinary rounds and team huddles are occurring.
• Provides direction to the multidisciplinary team as needed in difficult cases.
• Obtains, interprets, and presents metrics related to care management.
• Attends key meetings and presents information about existing case management processes.
• Develops the performance improvement plan of the care manager, documents performance, and provides performance feedback.
• Evaluates the work of the team member and provides reward and recognition for proper and efficient performance.
• Determines areas of opportunity and suggests process improvement.
• Follows HR policies for performance and disciplinary action; responsible for disciplinary action and performance improvement plans when appropriate.
• Participates in departmental preparation for regulatory visits and compliance audits.
• Coordinates/facilitates patient care progression throughout the continuum by working collaboratively with the multidisciplinary team.
• Collaborates with ancillary departments to ensure accuracy of patient demographic and insurance information.
• Assists in the collection and reporting of indicators tracking efficiency of case management processes.
• Uses data to drive decisions and plan/implement performance improvement strategies related to assigned staff, including fiscal, clinical, and patient satisfaction data.
• Collaborates with Physician Advisors/Hospitalists in needs related to Case Management and difficult cases.
• Maintains annual competencies and ensures training and continuing education of the team in applicable platforms (Epic, Xsolis Cortex, BI, Google Suites).
• Assumes responsibility for supervision of other case management care coordination managers in the absence of a Supervisor.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Requirements

• Bachelor's degree in Nursing or Master's Degree in Social Work.
• At least 3 years of full-time experience in an acute care setting.
• Familiar with hospital resources, community resources, and/or resource/utilization management.
• Care coordination, case management, or discharge planning experience.
• Effective decision-making/problem-solving skills, demonstration of creativity in problem-solving, and influential leadership skills.
• Excellent verbal, written, and presentation skills.
• Moderate to expert computer skills, including Microsoft Office and/or Google Suite platforms.

Qualifications

• Registered Nurse (RN) with current New Jersey (NJ) License, or Licensed Social Worker (LSW) or Licensed Clinical Social Worker (LCSW).
• Case Management certification by a nationally recognized organization within 1 year.

• Basic Cardiac Life Support Certificate (preferred).

Pay

Minimum rate of $107,952.00 annually. The posted rate of pay is a reasonable good faith estimate of the minimum base pay for this role at the time of posting and does not reflect the full value of our market-competitive total rewards package. The base compensation determined at the time of the offer may differ based on factors including labor market data, experience, education, certifications, skills, geographic location, internal equity, budget, and grant funding.

Benefits

HMH offers a comprehensive benefits package for full-time and part-time (20+ hours/week) job positions, including:

• Health, dental, and vision benefits.
• Paid leave.
• Tuition reimbursement.
• Retirement benefits.

Certain positions may also be eligible for performance-based incentives, bonuses, commissions, and shift differentials for work performed on evening, night, or weekend shifts.