Supervisor, Utilization Management RN

Job Summary

The Supervisor of Utilization Management (UM) RN is responsible for overseeing the day-to-day operations of the UM department, managing staff performance, and ensuring compliance with regulatory requirements and organizational policies.

Duties

• Ensures adequate/appropriate distributions of workforce, assignments, and time off requests.
• Monitors staff's performance, including productivity and compliance with regulatory requirements, and provides recommendations for improvement.
• Serves as the primary resource for staff-related questions and escalates issues to appropriate leaders.
• Recommends and implements process improvement measures to achieve departmental performance outcomes and goals.
• Plans and oversees UM activities according to the model of care, program description, and policy and procedures.
• Maintains assigned reporting responsibilities and conducts regular audits to ensure compliance with community, industry, and organizational standards, including regulatory requirements.
• Serves as a super-user on electronic programs and systems used by the department.
• Assists in the development of programs, workflows, tools, training materials, orientation checklists, and competency checklist necessary to meet educational needs.
• Trains new staff, remediation of seasoned staff, and cross-training as needed in specified business lines.

Qualifications

• Minimum of 7 years of acute/clinical care experience.
• Minimum of 2 years of experience in Case/Care/Utilization Management in an acute care or health plan setting.
• Minimum of 3 years leading process, program, or staff or supervisory experience.

Skills

• Knowledge of state, federal, and regulatory requirements in Care/Case/Utilization Management.
• Strong verbal and written communication skills.
• Computer literacy with proficiency in Microsoft Word, Excel, and ability to learn core departmental computer systems and software.
• Excellent organizational, time management, and interpersonal skills.
• Detail-oriented, energetic, and enthusiastic team player.
• Able to work independently.

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retail Plans
• Medical, Dental, and Vision Insurance
• Wellness Program
• Volunteer Time Off (VTO)