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Supervisor, Utilization Management

Beaverton, OR · Healthcare
Position Overview:
Our client is seeking a Health Care Services (HCS) Clinical Support Supervisor to be responsible for the daily operations of the Utilization Medical Management department. This position oversees the registered nurses and technicians within the Utilization Medical department.  The supervisor  works collaboratively with the Manger of UM to meet the goals of the department. This includes proactively managing inpatient utilization to assure that medical care is appropriate, efficient and medically necessary, while supporting discharge planning efforts, transfers and coordination of care. The supervisor is a liaison to hospitals, skilled nursing facilities, health plans, and other departments. In this role, the supervisor acts as a mentor and role model; problem solving day to day issues and promotes team building that reflects the mission and core values.

 
Responsibilities:
  • Oversee the daily activities of staff, including hiring and performance management.
  • Provide day to day oversight for department operations and problem solving as issues arise.
  • Provide a supportive, team-based environment that facilitates group decision making and employee empowerment.
  • Evaluate performance and initiates personnel actions such as hiring, merit increases, probationary and periodic reviews, promotions, transfers between teams and disciplinary actions.
  • Develop and maintain positive relationships with providers and facilities; maintain knowledge in subject matter and enhance Health Plan expertise in the area of CM and UM.
Qualifications:
  • Bachelor's Degree in Health related field or applicable work experience may be substituted for some education.
  • 2 years experience with managed care services including population health initiatives, Affordable Care Act, Coordinated Care Organizations, Accountable Care Organizations, Medicare and Medicaid regulations.
  • Experience with development of innovative and focused partnerships and programs which challenge the norm to support an ever changing healthcare environment.
  • Experience in cost stewardship using Lean principles or other means which increase effectiveness and cut waste.
  • Experience with the latest trends in health education and behavior change.
  • Demonstrated experience in project management, educational program development and implementation, and technology.
  • Current licensed driver.
Preferred Qualifications:
  • Advanced Degree
  • Bachelor’s degree in Nursing or related field
  • Additional job-related and company approved certifications such as Certified Nursing Assistant, Certified Medical Assistant or Certified Med Aid.  
  • Active, unrestricted Oregon or Washington RN license
  • Certification in Utilization Management or Case Management 
  • 2 years clinical experience in an inpatient or outpatient healthcare setting
  • Supervisory or management experience in a managed care setting
  • Concurrent review  knowledge  and experience  using utilization management tools such as Interqual or Milliman criteria
  • Demonstrated ability to effectively manage change and conflict 
  • Demonstrated ability to work effectively with others as a team member
  • Attentiveness to detail, exhibiting self-direction, effective oral and written communications skills
Benefits:
  • Medical, dental and vision insurance coverage that start on your first day
  • Retirement program that helps you prepare for your future
  • Life and AD&D insurance
  • Health Reimbursement and Savings Accounts (HRA, HSA, FSA)
  • Health assessment and personal coaching to help you meet your goals
  • Incentives for participation in healthy activities
  • Caregiver Assistance Program (for employees) offering work/life services, resources and expertise when you need it
  • Weight management, tobacco cessation and diabetes programs
  • Volunteers in Partnership program to match you with volunteer opportunities that support our communities
  • Support for life events such as birth, adoption, marriage or other changes to your family
  • Ergonomics and injury prevention to promote safe work environments
  • Paid time off
  • Disability benefits
  • Tuition reimbursement to support your education as you tackle your career goals
Kat Forester
ProEnlist, LLC

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