Are you a leader?

A medical professional who leads by proactive example?

Pay Range: $44 -$51 with stipend!

Work Schedule: Mon-Sat, 8:00a - 4:30p

We are seeking a medical professional for the role of Supervisor of Utilization Management.

You will be taking on the role of utilization management Department and Prior Authorization (PA) teams, including hiring, scheduling, coaching, development, and evaluation of employee performance. Analysis of available data to measure individual and team performance, clinical program performance, team processes, and compliance are essential.

Working with staff, you will anticipate and resolve complex issues to ensure accurate and cost-effective operations and the achievement of productivity and quality metrics.

You will work in conjunction with the Director of UM on a variety of critical tasks including the management of one or more focused clinical initiatives and representing the company externally in presentations with key provider and payer groups that integrate state and federal regulations to ensure compliance with regulatory requirements. This position's oversight responsibility is to plan, develop, and direct the Utilization Management Department, including the sections for authorizations and concurrent review. Develops and implements effective and efficient standards, protocols, and processes; department decision support systems; and reports and benchmarks that support the continual enhancement of utilization management functions and promote quality health care for members.

Minimum Qualifications

RN CA License required - Graduate of an accredited school of nursing.

Five or more year of clinical experience is required.

Three to five years of Utilization Management experience is required.

One to three years of charge/lead/supervisory/management experience required.

Ability to demonstrate leadership and management skills.

7 years of UM experience with Charge/Lead/Supervisory/Management experience in the Utilization Management

department.

Experience working with health plan auditors.

Bachelor of Science in Nursing and/ or Master's level degree preferred

Working knowledge of InterQual. Knowledgeable of NCQA and ICE.

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