Utilization Management Supervisor

The Supervisor, Utilization Management provides clinical guidance, supervises and monitors the daily workflow for Authorizations within Health Resources Management (HRM) with a focus on appropriate utilization of services and appropriate outcomes.

Key Tasks and Responsibilities

• Provide clinical expertise, guidance and supervision to the Authorizations staff including clinical and non-clinical staff. Lead by example and act as a resource to staff by resolving clinical and benefit issues.
• Manage staff production and overall inventory to ensure turnaround times are meeting department and regulatory goals
• Manage the prospective, concurrent and retrospective review process to ensure performance and regulatory standards are met.
• Research, file preparation and readiness for health plan audits
• Assist in setting and achieving unit and department goals/standards consistent with business objectives.
• Monitor productivity and other metrics to ensure turnaround times, working oldest authorizations first and other goals are met
• Support implementation of department policies and procedures.
• Participate in recruitment, retention of staff, and training.
• Support a positive work environment, motivating staff and fostering teamwork.
• Evaluate employee performance and provide appropriate feedback.
• Serve as a resource for physicians, providers, members and staff.
• Meet with staff, communicate and receive feedback on operational issues.
• Communicate and reinforce department policy and procedures. Participate in annual review and revision while collaborating with other regions to ensure consistency in application.
• Share accountability for managing the department budget and ensuring appropriateness of expenditures such as supplies and overtime.
• Process authorization approvals and denial letters as needed.
• Other duties as assigned.

Skills and Experience

• Active, unrestricted California Licensure: Registered Nurse (RN)
• Minimum three years clinical nursing experience.
• Minimum two years Utilization Management experience, preferably in managed care.
• Supervisory experience and/or demonstrated leadership skills preferred.
• Strong leadership, organizational, and communications skills.
• Ability to work effectively with a variety of customers including physicians, managers, providers, office staff, health plans and internal staff members.
• Proficient in MS office applications.
• Strong computer skills for application implementation and monitoring as well as mentoring staff on these applications.
• Experience with Epic/Tapestry preferred.

Salary Range

$110,000 - $120,000 (DOE and work location)

This position will have an (up to 8%) annual performance bonus earning potential and offers a full suite of benefits including 6.5% 401k matching.

PLEASE NOTE: We are only seeking candidates who are in/near San Ramon, Sacramento, or Stockton, CA and willing to work a hybrid (two days per week in office) work schedule.

At Hill Physicians Medical Group, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Additional Information

We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and one of the “Healthiest Places to Work in the Bay Area.” We have an award-winning Wellness Program, and our average tenure is ~8 years. Every person who joins Hill Physicians is coming in as a leader and has the very real potential to grow with the company as we grow. We’re all in it for the long haul and are bought-in to the success and future of our organization.

We’re proud to have been (and continue to be) a pillar of the Northern Californian healthcare community for more than 30 years. Our more than 5,000 primary care physicians and specialists provide high-quality care across the San Francisco Bay, Sacramento, and Central Valley areas.

By adapting to both the demands of the industry and the needs of consumers, we’ve remained stable and profitable, and our service area now ranges from the Pacific Ocean to the Sierra Nevada’s. We’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Our culture is guided by core values​ that promote the health and wellness of our employees and communities (health), commitment (accountability), fiscal responsibility (stewardship), teamwork (collaboration), and our dedication to do the right thing (integrity). 97% of employees feel that supervisors and managers “walk the talk”​ and demonstrate our core values. Join us!

Hill Physicians is an Equal Opportunity Employer

Job Type: Full-time

Pay: $110,000.00 - $120,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Healthcare setting:

• Long term care
• Outpatient

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: Hybrid remote in San Ramon, CA 94583