This position hasresponsibility for the day to day operations and decisions of the assignedclinical services department activities as they relate to Utilization Managementof referrals for ambulatory services.The supervisor will be responsible for primary supervision ofutilization nurses and support staff. This position will support the UM Managerand Director in achieving Medical Management initiatives for cost saving, implementinggrowth and development plans while supporting the strategic goals of thefoundation.
Essential Functions and Responsibilities of the Job
Demonstrates consistent performance, monitor staff for implementation of Utilization Management regulation, guidelines and standards to meet CMS, NCQA and health plan compliance.
Ability to apply common sense, collaboration and communication in the assessment, development and deployment of all assigned tasks and responsibilities.
Consistently demonstrates ability to practice and model a positive communication style that fosters open and honest feedback and contributes to a team centric environment that produces top quality results.
Sets and models high performance standards with integrity, ensures effective and productive work ethics, and teamwork for the Utilization Management team.
Be present and available to team members for problem solving and resolution management.
Follow company policies, procedures and directives
Interact in a positive and constructive manner
Prioritize and multitask
Manages day to day oversight of activities associated with Utilization Management nurses and supports UM Manager in the oversight of coordinators for the management of referrals, regulatory compliance, critical analysis of criteria and clinical history to make referral determinations for approvals and or denials.
Identify, develop and conduct training for staff and/or coordinate with trainer for new hires or when additional training is needed
Assign, manage, and/or handle special projects delegated by Manager and Director.
Develop and implement quality and productivity standards then establish the expectations with the staff in the performance of their jobs.
Interface with other departments to resolve issues associated with cases managed by the staff.
Participate in quality improvement activities for departmental specific processes.
Evaluate personnel to coach, counsel and/or discipline employees as necessary to improve performance.
Monitor time and attendance of assigned staff.
Provide support to U.M. Manager, Director, and Medical Director.
Ability to problemsolve to logical conclusion and demonstrates initiative and responsibility
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