Supervisor Utilization Management

Sacramento, CA 95833

Posted: 01/13/2021 Category: Nursing Job Number: 51551

Job Description


Full time Utilization Review Nurse Supervisor openings in the Sacramento, CA 95833 area with a major healthcare company! Starting ASAP! Apply now with Luke H. at A-Line!

 

Position Purpose: Supervise the daily operations of the utilization management (UM) department

 

Education/Experience:
  • 3+ years of utilization management/quality improvement, Claims BG, and appeals experience.
  • Working knowledge and understanding of basic utilization management and quality improvement concepts.
  • RN license highly preferred, but would consider an LVN with a strong and relevant background.
  • Supervisor experience preferred; open to candidates with strong clinical background (i.e. Leads)

 

Pay: $40 - $55 hourly (determined on licensure/qualifications)

Schedule:
  • 2-4 weeks of training- 40 hours/week and 8 hours/day from Mon-Fri (Potential Overtime for weekends)
  • Currently WFH, but appeals team will be going back into the office at some point.

 

Responsibilities:
  • Supervise the daily operations of the UM staff
  • Ensure appropriate usage of resources in order to facilitate the UM process
  • Ensure compliance within applicable state program guidelines
  • Evaluate compliance policies and procedures and analyze/recommend enhancements
  • 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 in order 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
  • For MCOs, supervise the Transition of Care staff and provide face to face contact with inpatient members at assigned hospitals
  • Will be directing daily work for the clinical team.
  • Will also collaborate heavily with the non-clinical team
  • Will be monitoring the incoming and outgoing work of the nurses.
  • Will shift work to nurses and follow up with them frequently.
  • Supervisor is responsible for making sure the incoming work is being completed and dispositioned appropriately.
  • Prime responsibility is delegation.
  • Will be helping with staff meetings and conducting daily touchbases to ensure work is good
  • Depending on how long this supervisor is on assignment, they may help with interviews
  • Will be managing 8 perm staff and 4 temps. No more than 15, but on average 10-15
  • Supervisor needs to make sure their expected work is being completed and the team is meeting TATs
  • Metrics they are holding others accountable to: staff is required to complete 8 pieces of work. Leads are expected to complete 4 pieces of work.

 

Why Apply:
  • Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
  • 401k after 1 year of employment: With employer match and profit sharing
  • GREAT Hours! Monday through Friday, 40 hours per week
  • Competitive Pay Rate


 

Keywords: Utilization Review, Utilization Management, Registered Nurse, MCO, RN, LVN, Licensed Vocational Nurse, Managed Care, Medical Claims, Appeals, Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Patient Counselor, Healthcare, Inbound Calls, Outbound Calls.

Send an email reminder to:

Share This Job:

Related Jobs:

Login to save this search and get notified of similar positions.