Utilization Management Supervisor

About This Role

Supervise the Utilization Management team for Outpatient Services, ensuring adherence to department policies, processes, and health plan requirements related to referrals and pre-certifications. This role involves leading the team through change, tracking performance metrics, and acting as a subject matter expert for staff, physicians, and office staff.

Responsibilities

• Educate all AUM staff on department policies, processes, and health plan requirements for referrals and pre-certifications
• Oversee staff assignments to facilitate referral processing in accordance with established policy
• Serve as staff resource for Clinical Operations and Compliance within the Clinical Services division
• Motivate and lead the team through change in a rapidly growing and evolving department and industry
• Maintain tools and reporting for tracking ongoing status of department operations and employee performance metrics
• Assist the AUM staff in the daily generation and processing of referrals, denials, appeals, and activities
• Provide education to newly hired AUM staff and ongoing training to all AUM staff
• Prioritize daily work and adjust staff assignments to promote compliance with documentation, turnaround times, and AUM activities
• Monitor phone queue statistics and provide consistent feedback to staff on performance metrics
• Act as a resource and subject matter expert for staff, Physicians, and office staff regarding referral processes, health plan benefits, and AUM activities

Requirements

• High school Degree
• Prior Operations Experience
• Proficient in use of Microsoft Office (Outlook, Word, Excel, PowerPoint)

Qualifications

• High school Degree Required
• 3+ years of Managed Care experience preferred; Prior Operations Experience Required; Leadership experience preferred

Nice to Have

• 3+ years Managed Care Experience
• Leadership experience
• EPIC experience

Skills

* Required skills

Benefits