Utilization Management Supervisor (Hybrid)

Supervisory Responsibility

This position manages people.

Essential Functions

• Supervises the daily operations of UM staff.
• Recruits, retains and develops a high performing team.
• Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures.
• Ensures appropriate usage of resources in order to facilitate the UM process.
• Educates staff as necessary to ensure consistent performance and adherence to standards.
• Evaluates compliance policies and procedures and analyzes/recommends enhancements.
• Facilitates the collection and validation of data from UM staff to ensure consistency and accuracy.
• Assists in analyzing and reporting data used to support the achievement of corporate objectives, enhance operational monitoring and meet external reporting requirements.
• Evaluates departmental processes and recommends improvement opportunities to enhance operational efficiency and support departmental objectives.
• Provides timely communication to management regarding department operations including customer and case-related issues, operational trends, variances, reporting outcomes, action plans, etc., to support informed decision-making.

Qualifications

• Education Level: Bachelor's Degree in Nursing OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
• Experience: 3 years Medical/surgical experience including, but not limited to, inpatient care, outpatient/home care and hospice care, and experience reviewing patient medical care with demonstrated leadership.
• Licenses/Certifications Required Upon Hire RN - Registered Nurse - State Licensure And/or Compact State Licensure
• Knowledge, Skills And Abilities (KSAs): Excellent analytical, problem-solving skills with ability to judge appropriateness of member services and treatments on a case by case basis. Ability to multitask, prioritize and maintain a dynamic personal organization system that allows for flexibility. Knowledge of accreditation standards and federal/state regulations and general principles relating to utilization review. Effective written and interpersonal communication skills to engage with members, healthcare professionals, and internal colleagues. Computer skills, including Microsoft Office programs. Ability to mentor and coach associates to accomplish goals, provide objective evaluation of associate performance, and implement strategies to improve individual and team-based performance as needed.

Travel Requirements

Able to travel to CareFirst sites for meetings and off site Health Services meetings.

Salary Range

$82,800 - $170,775

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Physical Demands

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.