Supervisor Utilization Management - Government Programs

Arkansas Blue Cross Blue Shield

3d • Onsite

About The Position

The Supervisor Utilization Management - Government Programs provides leadership and oversight to the utilization management team, ensuring day-to-day activities align with timelines and quality standards. The key responsibilities for this role involve monitoring utilization review activities and outcomes and staff oversight.

Requirements

• Associate's degree in Nursing required.
• Registered Nurse with current, unrestricted, licensure required for state of Arkansas or multistate licensure.
• Minimum five (5) years' Clinical experience with minimum two (2) years' experience in Utilization Management and Managed Care required OR applicable Masters in related field with minimum three (3) years' experience.
• Minimum two (2) years' Government programs experience in Medicaid, Medicare and/or Federal Government Programs.
• Demonstrated success as an individual contributor in current or related operational/functional area.
• Active Learning
• Coaching Others
• Cross-Functional Communications
• Decision Making
• Employee Engagement Strategies
• Evaluating Information
• Interpersonal Relationships
• Management Techniques
• Monitor Processes, Materials, or Surroundings
• Oral Communications
• Problem Solving
• Researching
• Service Oriented
• Written Communication

Nice To Haves

• Bachelor's degree in Nursing preferred.
• Experience working in regulatory and compliance requirements strongly preferred.
• Experience with Milliman or InterQual guidelines preferred.

Responsibilities

• Collaborates with hospital staff, care coordinators, and plan leadership to ensure members receive the appropriate level of care.
• Communicates directly with appropriate internal staff regarding inpatient cases and outpatient/ambulatory requests not meeting medical necessity requirements and out of network transfer issues.
• Contributes to program goals and objectives focused on cost containment and maintains a high-quality medical delivery system.
• Ensures continuity of care for inpatients through early discharge planning and collaborating with hospital and health plan staff to identify home care candidates or less restrictive care options.
• Ensures safe transitions to outpatient settings by improving self-management skills and addressing members psychosocial and non-medical needs.
• Identifies and manages high risk members by collaborating with Case Managers to coordinate post-discharge care, ensuring timely outpatient follow-up, adherence to treatment plans, and proper medication and service implementation.
• Maintains and submits reports and logs on review activities per standard operating procedures.
• Maintains compliance with state mandated regulations.
• Manages staffing logistics, specifically preparing schedules, assigning work, and adapting to changing priorities to meet both internal and external demands.
• Performs other duties as assigned.
• Performs utilization management and concurrent review for hospitalized members.
• Supervises the hiring, coaching/training, employee development and performance management of Utilization Management team.

Benefits

• Tuition reimbursement.
• Club Blue, a free, onsite gym to encourage exercise.
• Green Leaf Grill and Green Leaf Grill Express, onsite restaurants in Little Rock that promote healthy eating.
• Incentives for wellness education and exercise

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree