Supervisor Care Coordination
About The Position
The Clinical Care Coordination Supervisor oversees daily operations of the utilization management team, ensuring compliance with regulatory standards, organizational policies, and industry best practices. The role supports staff development, monitors performance, and promotes high-quality, cost-effective care coordination. The supervisor leads and supports Referral Coordinators for various health plans. Responsibilities include ensuring compliance with utilization management processes, evaluating eligibility for benefit coverage, and collaborating with internal and external stakeholders to optimize patient care. The role also works closely with health plan case managers and claims payers to facilitate appropriate care coordination and accurate claims processing.
Requirements
- Bachelor's degree in Nursing (BSN), Healthcare Administration, or a related field.
- Minimum of 3–5 years of experience in utilization management, case management, or a related healthcare setting.
- At least 2 years of leadership or supervisory experience in a healthcare environment.
- Strong understanding of utilization management, medical necessity criteria, and regulatory compliance, including CMS, NCQA, and URAC.
- Proficiency in Microsoft Word, Excel, and PowerPoint.
- Excellent leadership, problem-solving, and decision-making abilities.
- Strong communication and interpersonal skills for cross-functional collaboration.
- Uphold compliance principles as outlined in the Code of Conduct and related policies.
- Participate in mandatory Corporate Compliance Program training annually or as required.
Responsibilities
- Oversee daily operations of the utilization management team and ensure compliance with regulatory standards, organizational policies, and industry best practices.
- Support staff development and monitor team performance.
- Promote high-quality, cost-effective care coordination.
- Lead and support Referral Coordinators serving various health plans.
- Ensure compliance with utilization management processes.
- Evaluate eligibility for benefit coverage.
- Collaborate with internal and external stakeholders to optimize patient care.
- Work with health plan case managers and claims payers to facilitate appropriate care coordination and accurate claims processing.
- Uphold compliance principles in the Code of Conduct and related policies.
- Support and participate in mandatory Corporate Compliance Program training annually or as required.
Benefits
- Medical insurance
- Vision insurance
- Dental insurance
- Short- and long-term insurance
- 6+ days of holiday pay
- 13 days of PTO
- Employer-paid life insurance
- 401(k) with employer contribution
- Wellness program with reward incentives
- Employee recognition and reward programs
- Comprehensive paid training program
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What This Job Offers
Job Type
Full-time
Career Level
Manager
