Supervisor, Utilization Management - Operations

Medica•Minnetonka, MN

3d•Hybrid

About The Position

This position is accountable for the day-to-day and strategic activities of the assigned review coordinator team. This position is also accountable for achieving results and maintaining flexibility to meet business needs. Responsibilities include the supervision of team members, ensuring that strategic processes are established, communicated and accomplished, and facilitating interdepartmental communications. This position resides in Health Management yet interacts regularly with other business segments within Medica. This position assists in developing, maintaining, executing, and overseeing of end-to-end operational processes for triage and processing of all provider-related submissions and questions related to inpatient notification and discharge information and prior authorizations. In addition, this position is responsible for process documentation and implementation, facilitating process improvement opportunities, and on-going maintenance of departmental processes. The Supervisor, Utilization Management - Ops oversees a team of Review Coordinators who serve as a central point of contact for operational issue identification, escalation, and resolution. This role drives operational excellence by identifying and implementing process improvements across Utilization Management and related departments, coordinating cross-functional initiatives, and ensuring resources are aligned to support business objectives. The Supervisor plays a key role in the development, planning, and execution of departmental and enterprise projects that support Utilization Management operations. The Supervisor, Utilization Management - Ops is responsible for the day-to-day leadership and performance of the assigned team, ensuring operational goals, service standards, and business objectives are achieved. This role establishes and communicates strategic priorities, fosters collaboration across departments, and supports organizational agility in response to evolving business needs. Positioned within Health Management, the Supervisor partners regularly with leaders and teams across Medica to drive effective outcomes and continuous improvement.

Requirements

Bachelor's degree or equivalent combination of education and work experience
3+ years of direct leadership experience, either through managerial experience or through leadership roles that require coaching, mentorship and performance evaluation
3+ years healthcare experience
Strong verbal and written communication skills with the ability to effectively engage stakeholders at all levels of the organization
Strong analytical, critical thinking, and problem-solving skills with the ability to assess issues, make sound decisions, and drive results
Ability to influence, build relationships, and collaborate effectively across teams and functions
Proven leadership skills, including coaching, employee development, accountability, and delegation
Ability to adapt to changing business needs and navigate complex situations with agility and professionalism.
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

Nice To Haves

Prior leadership experience in Utilization Management, Prior Authorization, or related health plan operations
Experience leading and developing teams in a virtual, metrics-driven environment
Demonstrated experience coaching, mentoring, and developing employees, including performance management and annual performance reviews
Experience leading change initiatives and implementing operational processes that improve performance, efficiency, and business outcomes
Experience managing projects and driving cross-functional initiatives from planning through execution.

Responsibilities

Ensures workflow is efficient and effective.
Ensures requests are completed within department standards and comply with regulatory guidelines.
Identifies and assists in resolution of escalated and/or complex issues.
Tracks and trends issues and completes root cause analysis
Communicates and implements department/team changes and decisions
Oversees team functions including, but not limited to, timecard approval, personal time off reviews, etc.
Facilitates start to end hiring process. Includes interviews, appropriate paperwork and onboarding schedule
Maintains accessibility and availability to facilitate problem solving and resolution of case reviews and complex issues
Ensures policy and procedures are effectively managed and implemented
Develops new and oversee the monitoring and updating of department SOPs (standard operating procedures). Collaborates with team and communicates as needed
Demonstrates ability to prioritize and distribute high volume of requests, communicates plan to team as needed
Identifies and initiates process improvements
Assists in department process improvement planning, implementation and training related to audit findings and Corrective Action Plans
Supports daily operations and long-range planning for department
Collaborates with department and all business segments to ensure consistent, effective and timely communication occurs
Works with internal and external stakeholders to ensure accurate system set-up and maintenance
Communicates accurate and timely information to team members to enhance the effectiveness and efficiency of performance
Encourages staff to identify potential areas for improvement and work efficiencies.
Identifies streamlining opportunities
Provides technical support by researching and responding timely to complex questions and issues
Provides ongoing coaching and development for new and existing team members on a regular basis.
Assesses and develops colleagues for success
Provides both positive and constructive feedback with prompt training and/or coaching if necessary
Performs regular audits on scope of work to ensure department guidelines, processes and turn-around times are being followed
Conducts regular one on one meetings to discuss performance and opportunities for improvement and growth as needed
Sets individual performance goals and facilitate the creation of individual learning plans
Prepares and presents performance reviews annually
Provides recognition to individuals through reward and recognition programs
Oversees a variety of related projects: complex initiatives and projects, large-scale Health Management initiatives, key or high-visibility cross-department initiatives
Identifies requirements and expectations, defines deliverables, and develops project work-plans (including time and resources commitments) with department/business segments.
Tracks and communicates project status with department/business segments
Understands and communicates the key strategic or operational purpose of projects.
Develops content expertise on assigned projects
Contacts and coordinates resources (other departments) to resolve identified issues in an effective and timely manner
Anticipates issues and potential obstacles. Assists department/business segments in identifying appropriate solutions
Participates as business SME (subject matter expert) on system projects that impact department core processes
Conducts effective meetings, including development of agendas and meeting minutes
Performs other duties as assigned