Supervisor Utilization Review Care Management

Job Description

Facility: Administrative Regional Training Cntr

Shift: Shift 1

Status: Full Time FTE: 1.000000

Bargaining Unit: ACE Associates

Exempt from Overtime: Exempt: Yes

Work Schedule: Days

Hours:

Primary 8-4pm

Summary:

In concert with the Director of Care Management, site leadership, and the site supervisor of Care Management, this position is responsible to direct, manage and lead the overall functions of the utilization review team to ensure consistent, effective and efficient site specific utilization review, medical management, for patients across our continuum. Accountable for success in achieving site specific and system wide utilization review performance, productivity standards, fiscal/financial targets as well as select quality targets. Providing clinical and operational oversight to the utilization review care management staff as it relates to the care management continuum. Accountable for effective, efficient, and best practice patient flow as it relates to utilization review process including in the acute and emergency center settings. Serves as subject matter expert and coach ensuring accurate and timely reviews and resource utilization stewardship.

Responsibilities:

EDUCATION

• Bachelors of Science in Nursing preferred
• Registered Nurse licensure
• Care Management Certification preferred
• IQCT Certification preferred
• IQER Certification preferred

EXPERIENCE

• At least one (1) year of experience of supervising clinical teams aimed at improving the delivery of utilization management using evidence based principles and change management
• Minimum of three (3) years of acute care nursing experience required
• Proficiency in utilization management and regulatory requirements required

KNOWLEDGE, SKILL AND ABILITY

• Understanding of clinical quality and utilization metrics used to design value based contracts and measure performance in health care
• Fosters trust and exchange of ideas across departments to innovate and hardwire highly reliable practices
• Ability and skill to create a learning environment and foster positive growth
• Ability to manage in a complex and demanding contractual relationships
• Strong organizational skills, attention to detail, ability to work under pressure to balance competing priorities and meet deadlines
• Ability to produce and synthesize data to analyze success and learning opportunities and take action accordingly
• Seeks out learning opportunities to enhance professional growth and development
• Understanding of relevant aspects of payer contracts
• Ability to use computer programs including Word, Excel, and PowerPoint

WORKING CONDITIONS

• Routine travel between acute care facilities may be required
• Normal heat, light space, and safe working environment; typical of most office jobs