The job below is no longer available.

You might also like

in Nashville, TN

  • $18
    est. per hour
    Burger King 18d ago
    Urgently hiring0.8 mi Use left and right arrow keys to navigate
  • $18
    est. per hour
    Burger King 3d ago
    Urgently hiring5.1 mi Use left and right arrow keys to navigate
  • $14.00 to $16.00
    Verified per hour
    Checkers 4d ago
    Urgently hiring3.3 mi Use left and right arrow keys to navigate
  • $13.00 to $14.00
    Verified per hour
    Checkers 4d ago
    Urgently hiring3.7 mi Use left and right arrow keys to navigate
  • $18
    est. per hour
    Sonic 5h ago
    Urgently hiring1.2 mi Use left and right arrow keys to navigate
Use left and right arrow keys to navigate
Hours Full-time, Part-time
Location Nashville, TN
Nashville, Tennessee

About this job

Utilization Management, RN Supervisor

Supervisor, Utilization Mgmt

Job Summary

Supervises daily Utilization Management (UM) operations and productivity including initial medical necessity review, continued stay review, discharge planning, and care coordination, and monitors individual staff caseloads and patient treatment plans to ensure delivery of timely and appropriate care. This position is responsible for assisting with staff training and auditing staff performance to ensure compliance with policies, UM related desk procedures, and accurate data entry and application of the Medical Management System. This position interacts with staff, Veterans and Veteran treatment facilities as the subject matter expert on UM program issues. This position also provides support to the non-clinical staff regarding UM related work.

Education & Experience

Required:

Registered Nurse, with current unrestricted license for appropriate state 4+ years clinical experience 2+ years Managed Care or equivalent experience Experience as a supervisor or department lead

Preferred:

o Bachelors in Nursing, Health Administration, or related field o Veterans' healthcare or equivalent experience o Certified Professional in Healthcare Management

Key Responsibilities

Supervises daily UM operations by overseeing clinical and non-clinical staff production, managing to production goals, auditing staff performance, coaching and developing staff. * Ensures staff is fully-informed of changes by communicating updates, policy revisions, performance outcomes, and significant events. * Prepares work schedules and monitors staff caseloads to ensure adequate staffing levels at all times and accurate data entry and application of the medical management system. * Assesses staff performance, advises and counsels as necessary, and conducts annual performance evaluations. * Participates in staff hiring and training process. * Monitors staff to ensure adherence to established criteria, including InterQual, internally developed guidelines, decision support tools, contract requirements and policies and desk procedures. * Provides guidance to staff and/or interacts with patients, providers and Veteran facilities on complex cases. * Reports Potential Quality Issues (PQI). * Implements work processes to ensure that requested case determinations and notifications meet contract compliance standards and identifies opportunities for process improvement.

Plans, organizes and implements staff in-service training and staff development activities. Ensures department meets all training requirements. * Assists manager with data collection and analysis of management reports. * Develops information managing performance and assists in updating desk procedures. o Performs other duties as assigned. o Regular and reliable attendance required

Competencies

Coaching / Training / Mentoring:

Actively foster actions required for desired business outcomes through ongoing constructive feedback

Communication / People Skills:

Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.

Computer Literacy:

Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Coping / Flexibility:

Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Delegation Skills:

Provide clear performance expectations for projects and ensure adequate access to resources for completion

Independent Thinking / Self-Initiative:

Critical thinkers with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources

Information Management:

Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

Leadership:

Successfully manage different styles of employees; Provide clear direction and effective coaching.

Multi-Tasking / Time Management:

Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment

Organizational Skills:

Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.

Problem Solving / Analysis:

Ability to solve problems through systematic analysis of processes with sound judgment; Has a realistic understanding of relevant issues.

Technical Skills:

Thorough knowledge of TRICARE policies and procedures, Case Management and Utilization Management principles, Managed Care concepts, medical terminology, alternative funding programs, community resources, medical practices and standards of care, and medical management on-line system. Proficiency in application of International Classification of Diseases, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental Association coding

About Aerotek: Aerotek, headquartered in Hanover, Md., is a leading provider of technical, professional and industrial staffing services. Established in 1983, Aerotek is an operating company of Allegis Group, the largest provider of staffing services in the U.S. Aerotek operates a network of more than 200 non-franchised offices throughout the U.S., Canada and Europe. For more information, visit aerotek.com. Aerotek is acting as an Employment Agency in relation to this vacancy.