Supervisor Clinical Utilization Management - Health Plan Utilization - Full-time / Part-time

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 position 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:

• Supervise the daily operations of the utilization management (UM)/Intake department
• Ensure appropriate usage of resources 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, to improve monitoring and reporting 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 judgement to forward to precertification nurse/care manager/case manager/medical director as appropriate
• Adhere to URAC standards Follows 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, scheduling, approving time off requests, tracking absences, timekeeping and managing overtime expenses.
• Completes Performance Reviews, provides recommendations and input into other employee reviews and disciplinary processes with staff
• Any other duties as directed

Requirements:

Work Type:

Full Time

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