Supervisor, Utilization Management

Responsibilities

• Supervise and maintain efficient department operational systems/process
• Comply with policy and procedures effectively and with appropriate documentation and ensure team meets all department, regulatory and accreditation requirements and goals
• Informs the Manager of process, procedure, policy and other issues that cannot be resolved within the team
• Model change management philosophies and support and facilitate a positive approach to change among team members
• Monitor team members’ calls and casework to ensure staff is following department guidelines, processes and turn-around times
• Manage performance and hold staff accountable for meeting department standards for quality, turn around times, policy application, effectiveness, attendance, and personnel management, etc.
• Formulate action plan for less than acceptable performance
• Consult human resources and manager to ensure compliance with company policies and values
• Responsible for personnel management including interview process, goals establishment, performance review, and team-building
• Aid in the delivery of new employee orientation programs for team members, and contribute to the development, maintenance and communication of educational programs as indicated
• Compile and report team and individual statistics for planning and evaluation
• Absorb and communicate workload and turn-around times
• Coach, encourage and facilitate individual growth and development through specific, timely and consistent feedback
• Conduct regular and timely one on one meetings
• Communicate management decisions in a positive manner to staff
• Accessible during workday to facilitate problem solving and resolution of case review issues and complaints
• Take phone calls, handle escalated issues and provide setting for clinical case consultations
• Provide technical and clinical support to staff by researching and responding to their questions
• Coach staff on the Quality Audit results
• Recommendations from audits are evaluated and appropriate improvement measures are taken
• Project and Group Management and Industry Knowledge
• Work closely with project management team on implementation of new and renewing clients and for new and ongoing company and department initiatives
• Exhibit skills in organization, project management, time management and meeting facilitation
• Assist in the development, implementation or maintenance of department programs, which reflect quality of service and care as delegated by the manager
• Represent Utilization Management at interdepartmental meetings and committees
• Establish and Maintain Positive Relationships with Internal and External Customers
• Assist in developing and maintaining strong, positive and open relationships with the employer groups and other internal and external stakeholders
• Listen to and understand customer’s questions, concerns or problems

Qualifications

• Bachelor's degree in nursing
• 5+ years of clinical experience beyond degree, with 2+ of those years being in Utilization Management
• 1+ years of leadership experience
• Registered Nurse (RN) with active Minnesota license required

Skills And Abilities

• Strong working knowledge of Medicare and Medicaid regulations, mandates, and compliance standards
• Expertise in communicating with staff in different positions and all levels of management positions
• Excellent customer service skills and proven team building skills
• Excellent computer skills including Microsoft Word, Outlook, Power Point and Excel
• High degree of initiative and ability to work independently, and within a group
• Demonstrated effective project management skills, including use of project planning and tracking tools; development of achievable goals, objectives, and timelines; and innovative use of resources
• Ability to plan, organize and prioritize work effectively, including the flexibility to accommodate frequent changes
• Strong problem solving skills
• Knowledge of NCQA, Motivational Interviewing, Evidence Based Medicine and coaching
• Consultant skills to articulate business needs and translate to quality programs that result in targeted staff competencies
• Strong leadership skills