Supervisor Clinical Utilization Management - Health Plans Admin

Summary:

The Supervisor Clinical Utilization Management is responsible for the clinical coordination and leadership of the Utilization Management, Referral, and Precertification Management information between the UM/CM department and providers. This Job is responsible for clinical evaluation of data, UM clinical evaluation of data and all reporting, and intake data reporting. Requirements include clinical licensure in a related field and the ability to manage, supervise, and orient intake/UM staff.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Supervise the daily operations of the utilization management (UM)/Intake department.
• Ensure appropriate usage of resources in order to facilitate the UM/Intake process.
• Assist with ensuring consistent data collection from UM staff that is used to assist the company in achieving corporate goals, and to improve monitoring and reporting in order to meet external requirements.
• Identify opportunities for process improvements necessary to facilitate department functions.
• Educate staff as necessary to ensure consistent performance and adhere to standards.
• Assist UM Manager and Director with coordinating and facilitating system processes with providers, partners, vendors, and subcontractors as necessary.
• Develop and train intake/UM staff.
• Manages staff of Intake Coordinators and/or Clinical UM Staff.
• Monitors caseloads, distribution, and productivity of all Intake Coordinators and/or Clinical UM Staff.
• Provide Internal Chart Audits.
• Prepares all Utilization Management reports, letters, and clinical analysis documents as requested.
• Collaborates with other departments within the organization.
• Identifies areas of potential improvement in workflow.
• Receive process and complete data entry of demographic information for all referral and authorization requests from providers via fax or phone and as appropriate, review clinical data and make professional, clinical judgment to forward to precertification nurse/care manager/case manager/medical director as appropriate.
• Adhere to URAC standards Follow CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPPA).
• Attend monthly departmental meetings and/or interdepartmental meetings as appropriate.
• Coordinates work hours of staff including, including scheduling, approving time off requests, tracking absences, timekeeping and managing overtime expenses.
• Completes Performance Reviews, and provides recommendations and input into other employee reviews and disciplinary processes with staff.
• Any other duties as directed.

Job Requirements:

Education/Skills

• Bachelor’s degree in nursing (BSN) required
• Master’s degree preferred

Experience

• 3 years of utilization management/quality improvement experience required
• Working knowledge and understanding of basic utilization management and quality improvement concepts required
• Previous experience as a lead in a functional area or managing cross-functional teams on large-scale projects required
• 2 years of nursing or other clinical experience in a hospital setting required
• Supervisory experience preferred

Licenses, Registrations, or Certifications

• RN licensure required 

Work Schedule:

TBD

Work Type:

Full Time

EEO is the law - click below for more information: 

https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at (844) 257-6925.