Utilization Management Supervisor

Duly Health and Care•Downers Grove, IL

4d•Onsite

About The Position

Utlization Management Supervisor - Downers Grove Position Highlights: Full-Time, 40 Hours/Week Location: Downers Grove Benefits: Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance. Access to a mental health benefit at no cost. Employer provided life and disability insurance. $5,250 Tuition Reimbursement per year. Immediate 401(k) match. 40 hours paid volunteer time off. A culture committed to community engagement and social impact. Up to 12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members once eligibility require Responsibilities The Supervisor, Utilization Management (Outpatient Services)/(AUM) is responsible for educating all AUM as to the Utilization Management (AUM) department policies, process and Health plan requirements relating to referrals and pre-certifications. This position is also responsible for overseeing staff assignments to facilitate referral processing in accordance with established policy. Serves as staff resource for Clinical Operations and Compliance within the Clinical Services division of Boncura/Duly Health and Care. Motivates team and Leads team through change in a rapidly growing and evolving department and industry. Maintains tools and reporting for tracking ongoing status of department operations and employee performance metrics related to daily productivity, and documentation compliance Ability to assess problems and prioritize work in a high volume, fast paced setting is required. Critical thinking skills required. Ability to effectively speak with Physicians and Medical Directors is required. Develops and maintains reference materials that support the AUM Department Policy and Procedure and are consistent with Health Plan, CMS, NCQA, or DOI guidelines as appropriate. Assist the AUM staff in the daily generation and processing of referrals, denials, appeals, and activities. Provides education to all newly hired AUM staff and provides ongoing training to all AUM Staff to ensure that all AUM Policy is appropriately understood and consistently applied. Prioritize daily work and adjust staff assignments to promote compliance with documentation, turnaround times, and compliance with all required AUM activities. Monitor phone queue statistics and provide consistent feedback to staff on performance metrics. Ensure that all incoming telephone calls to the queues are answered promptly, the caller’s issues are addressed, and any identified problems are brought to resolution when necessary Act as a resource and subject matter expert for staff, Physicians, and office Staff in regard to referral processes, health plan benefits, and processing of day-to-day AUM activities. Document all pertinent information obtained through discussion with providers, patients, family members and other health care professionals in appropriate EMR. Work collaboratively with leadership to develop/address corrective action plans as needed Maintain confidentiality, related to patients and employees, as stipulated in the confidentiality policy. Perform other projects and duties as related to department objectives. Qualifications EDUCATION High school Degree Required EXPERIENCE: 3+ years Managed Care Experience preferred Leadership experience preferred Prior Operations Experience Required Proficient in use of Microsoft Office (Outlook, Word, Excel, PowerPoint) EPIC experience preferred, but not required The compensation for this role includes a base pay range of $62,900-94,300, with the actual pay determined by factors such as skills, experience, education, certifications, geographic location, and internal equity. Additional compensation may be available through shift differentials, bonuses, and other incentives. Base pay is only a portion of the total rewards package.

Requirements

High school Degree Required
Prior Operations Experience Required
Proficient in use of Microsoft Office (Outlook, Word, Excel, PowerPoint)

Nice To Haves

3+ years Managed Care Experience preferred
Leadership experience preferred
EPIC experience preferred, but not required

Responsibilities

The Supervisor, Utilization Management (Outpatient Services)/(AUM) is responsible for educating all AUM as to the Utilization Management (AUM) department policies, process and Health plan requirements relating to referrals and pre-certifications.
This position is also responsible for overseeing staff assignments to facilitate referral processing in accordance with established policy.
Serves as staff resource for Clinical Operations and Compliance within the Clinical Services division of Boncura/Duly Health and Care.
Motivates team and Leads team through change in a rapidly growing and evolving department and industry.
Maintains tools and reporting for tracking ongoing status of department operations and employee performance metrics related to daily productivity, and documentation compliance
Ability to assess problems and prioritize work in a high volume, fast paced setting is required.
Critical thinking skills required.
Ability to effectively speak with Physicians and Medical Directors is required.
Develops and maintains reference materials that support the AUM Department Policy and Procedure and are consistent with Health Plan, CMS, NCQA, or DOI guidelines as appropriate.
Assist the AUM staff in the daily generation and processing of referrals, denials, appeals, and activities.
Provides education to all newly hired AUM staff and provides ongoing training to all AUM Staff to ensure that all AUM Policy is appropriately understood and consistently applied.
Prioritize daily work and adjust staff assignments to promote compliance with documentation, turnaround times, and compliance with all required AUM activities.
Monitor phone queue statistics and provide consistent feedback to staff on performance metrics.
Ensure that all incoming telephone calls to the queues are answered promptly, the caller’s issues are addressed, and any identified problems are brought to resolution when necessary
Act as a resource and subject matter expert for staff, Physicians, and office Staff in regard to referral processes, health plan benefits, and processing of day-to-day AUM activities.
Document all pertinent information obtained through discussion with providers, patients, family members and other health care professionals in appropriate EMR.
Work collaboratively with leadership to develop/address corrective action plans as needed
Maintain confidentiality, related to patients and employees, as stipulated in the confidentiality policy.
Perform other projects and duties as related to department objectives.

Benefits

Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance.
Access to a mental health benefit at no cost.
Employer provided life and disability insurance.
$5,250 Tuition Reimbursement per year.
Immediate 401(k) match.
40 hours paid volunteer time off.
A culture committed to community engagement and social impact.
Up to 12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members once eligibility require

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