Supervisor, Utilization Management – Authorizations (Hybrid, Remote Considered) - 26-05

PriMed Management Consulting•Sacramento, CA

28d•$106,000 - $135,000•Hybrid

About The Position

Provide clinical guidance, supervise and monitor the daily work flow for Authorizations within Health Resources Management (HRM) with focus on appropriate utilization of services and appropriate outcomes.

Requirements

Active, unrestricted California Licensure: Registered Nurse (RN) preferred
Minimum three years clinical nursing experience.
Minimum two years utilization management experience, preferably in managed care.
Supervisory experience and/or demonstrated leadership skills preferred.
Strong leadership, organizational, and communications skills.
Ability to work effectively with a variety of customers including physicians, managers, providers, office staff, health plans and internal staff members.
Proficient in MS office applications.
Strong computer skills for application implementation and monitoring as well as mentoring staff on these applications.
Experience with Epic/Tapestry preferred.

Responsibilities

Provide clinical expertise, guidance and supervision to the Authorizations staff including clinical and non-clinical staff.
Lead by example and act as a resource to staff by resolving clinical and benefit issues.
Manage staff production and overall inventory to ensure turnaround times are meeting department and regulatory goals
Manage the prospective, concurrent and retrospective review process to ensure performance and regulatory standards are met.
Research, file preparation and readiness for health plan audits
Assist in setting and achieving unit and department goals/standards consistent with business objectives.
Monitor productivity and other metrics to ensure turnaround times, working oldest authorizations first and other goals are met
Support implementation of department policies and procedures.
Participate in recruitment, retention of staff, and training.
Support a positive work environment, motivating staff and fostering teamwork.
Evaluate employee performance and provide appropriate feedback.
Serve as a resource for physicians, providers, members and staff.
Meet with staff, communicate and receive feedback on operational issues.
Communicate and reinforce department policy and procedures.
Participate in annual review and revision while collaborating with other regions to ensure consistency in application.
Share accountability for managing the department budget and ensuring appropriateness of expenditures such as supplies and overtime.
Process authorization approvals and denial letters as needed.
Other duties as assigned.