Utilization Review Supervisor

Guidehealth • Rockford, IL

2d • Remote

About The Position

UTILIZATION REVIEW SUPERVISOR Rockford, Remote In this position you will be working with a team of independent and autonomous Intake Coordinators and Utilization Review Nurses to break down barriers and ensure quality and timely determinations are delivered to providers and members. In collaboration with your department manager and the Leadership Team, you will strive for continuous improvement and an excellent work-life balance to produce top-notch results.

Requirements

• Current Registered Nurse License (State of Illinois requires Nursing Professional Staff to complete 20 hours of CE per 2-year license renewal cycle).
• Minimum of 3 years of experience Case Management, Managed Care, Health Insurance.
• Knowledge of utilization review, quality improvement, managed care, and/or community health.
• Excellent knowledge of case management principles, healthcare management, and reimbursement components, with experience in motivational interviewing,
• Excellent clinical judgment, as well as highly skilled in verbal and written communication.
• Strong organizational, problem solving, and time management skills.
• Ability to ensure timely completion of projects and assignments.
• Ability to prioritize and react based on rapidly changing business needs.
• Must have ability to work independently and remotely with multi-tasking skills for fast paced workflows.
• Must possess excellent software knowledge including word processing and spreadsheets, computer skills including MS Word, Excel, Access, PDF, Outlook, etc.
• Experience navigating multiple EMRs.
• A high speed/secured home internet connection, a home office with a door that locks for security and privacy purposes, and back-up connection service options for internet outages
• The required internet speed is a minimum of 100 mbps download, 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements.

Responsibilities

• Coordinating and providing care management and care that is timely, effective, efficient, equitable, safe, and member centered.
• Managing case assignments (outreach, documentation, case progression, and case closures), meeting reporting and documentation standards, and engaging in collaborative meetings with clients.
• Monthly attendance and coordination of UM/PHM Committee Meetings including material preparation, minutes, data collection and analysis, reporting and follow-up tasks.
• Training new and current employees with Preceptors. Re-education for audit fallouts.
• Assisting in creating, re-evaluating, and updating workflows/processes.
• Updating internal knowledge base and Confluence pages.
• Assisting in creation, re-evaluation, and analysis of necessary reporting, and identification of reporting opportunities.
• Attending and participating in virtual and in-person leadership meetings as necessary.
• Responsible for continued professional growth and education that reflects knowledge and understanding of current nursing care practice as outlined in the Illinois Nurse Practice Act.
• Other responsibilities as assigned, including assisting with payroll and monitoring FTO requests, as well as completing coaching and performance reviews with the team.
• Communication with IPA Administrators and Client Business Managers to ensure resolution of any concerns.

Benefits

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed