Supervisor, Utilization Management

Medica • Minnetonka, MN

4d • $78,700 - $134,900 • Hybrid

About The Position

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. This position is accountable for the day to day operational support and strategic activities of the assigned team. This position is also accountable for achieving department objectives and maintaining flexibility to meet business needs. Responsibilities include supervision of the clinical staff , ensuring that the strategic and business processes are established, maintained and communicated, and effective interdepartmental communications are established. This position resides in the Health Services department, yet interacts regularly with other areas within Medica. In addition to the coaching and staff development responsibilities, the Utilization Management Supervisor must also build strong relationships with internal and external partners. More specifically, support the Manager, Utilization Management in relationship building within Medica and its vendor partners to help prioritize, integrate and coordinate interventions for population segments based on medical, behavioral and social needs. This role oversees utilization management projects, initiates and participates in quality improvement activities, and performs data monitoring of utilization activity for reporting to internal customers. The Utilization Management Supervisor will possess a strong working knowledge of Medicare and Medicaid regulations, mandates, and compliance standards. The supervisor will support the manager and work with staff to integrate and understand accreditation requirements, and incorporate them into department activities. The supervisor will conduct job functions in a manner, which consistently promotes a high level of customer service to both internal and external customers, models and supports the company’s core values and basic principles. This includes but is not limited to maintaining constructive and professional relationships with peers, supervisory personnel and internal and external customers, navigating internally and externally, facilitating change and serving as a role model, and proactively meeting customer’s needs in a timely fashion. Performs other duties as assigned.

Requirements

• Bachelor's degree in nursing
• 5+ years of clinical experience beyond degree, with 2+ of those years being in Utilization Management
• 1+ years of leadership experience
• Registered Nurse (RN) with active Minnesota license required
• Strong working knowledge of Medicare and Medicaid regulations, mandates, and compliance standards.
• Expertise in communicating with staff in different positions and all levels of management positions
• Excellent customer service skills and proven team building skills
• Excellent computer skills including Microsoft Word, Outlook, Power Point and Excel
• High degree of initiative and ability to work independently, and within a group
• Demonstrated effective project management skills, including use of project planning and tracking tools; development of achievable goals, objectives, and timelines; and innovative use of resources
• Ability to plan, organize and prioritize work effectively, including the flexibility to accommodate frequent changes
• Strong problem solving skills
• Knowledge of NCQA, Motivational Interviewing, Evidence Based Medicine and coaching
• Consultant skills to articulate business needs and translate to quality programs that result in targeted staff competencies
• Strong leadership skills
• 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.

Responsibilities

• Supervise and Maintain Efficient Department Operational Systems/Process
• Supervise Performance of Utilization Management Team
• Project and Group Management and Industry Knowledge
• Establish and Maintain Positive Relationships with Internal and External Customers

Benefits

• Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager