Supervisor, Utilization Management

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 the staff with all care management processes, including LOS, throughput, patient flow and denials and appeals follow up.
• Applies process improvement methodologies in evaluating team member's 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 the 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 opportunities 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.
• Collaborates with ancillary departments to ensure accuracy of patient demographic and insurance information.
• Aids 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.

Qualifications

• Bachelor's degree, Nursing or Master's Degree in Social Work.
• At least 3 years 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.
• Excellent written and verbal communication skills.
• Proficient computer skills that may include but are not limited to Microsoft Office and/or Google Suite platforms.
• 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.