Utilization Management Supervisor

As a healthcare organization dedicated to providing quality services to the Central Coast community, our client is seeking a highly motivated Utilization Management Supervisor to join their team. The ideal candidate will be committed to the mission of improving the health and well-being of members of the community and will bring a combination of skills, experience, and passion to the role.

The Utilization Management (UM) Supervisor may be assigned to Utilization Management, case management-adult or case management-pediatric health operational unit. The UM Supervisor reports to the UM Manager in the related operational unit. This activity-oriented position requires the ability to coordinate day-to-day activities of their assigned unit and as appropriate, prepare timely reports of those activities to the department Manager and Director.

This position is expected to provide training to staff, identify areas for improvement, resolve any staff issues, provide new hire orientation and supervise staff as needed.

• Provide education and training to health services clinical and administrative staff
• Serve as a resource for other staff
• Identify areas for process improvements and assists with their implementation
• Support administrative and clinical staff in answering phone inquiries
• As assigned, perform retrospective claims review
• Carry a daily caseload of utilization or case management activities as assigned; supports clinical staff with day-to-day activities related to the review, coordination, care planning, and transition of care
• Interface with and serve as a resource to members and providers to clarify processes, answer questions, and address issues or concerns
• Handle and resolve daily issues, concerns and disputes of unit staff
• Provide new staff orientation and mentor activities
• Assist and coordinate staff assignments and coverages
• Identify problems or issues within established Utilization Management (UM) or case management (CM) processes, policies or procedures, and make suggestions for efficient resolution
• Identify process-oriented opportunities for improvement
• Assist with coordination and facilitation of regular staff meetings
• Participate in internal and external audits
• Supervise staff

Requirements

• Active, unrestricted California RN license.
• BA/BS degree preferred
• 1 year in a health plan or managed care setting is preferred.
• 1 year experience with Medi-Cal and Medicare lines of business
• Have experience as an RN in a lead, supervisory or management role preferred
• Have a proven track record of exemplary performance that are above or exceed expected performance and productivity levels

Compensation

• $90,347 - $140,037