Supervisor Utilization Management
- West Allis, WI
What you'll be doing
- Oversees, coordinates, and monitors all care access and monitoring clinical and non-clinical team activities to facilitate integrated proactive utilization management. Functions as hands-on supervisor for daily-integrated care access and monitoring activities. Manages and evaluates team members in the performance of various utilization management activities. Performs and promotes interdepartmental integration and collaboration to enhance the continuity of care including behavioral health and long term care for company members. Ensures adequate staffing and service levels, and maintains customer satisfaction by implementing and monitoring staff productivity and performance indicators. Collates and reports on care access and monitoring statistics including plan utilization, staff productivity, cost effective utilization of services, management of targeted member population, and triage activities. Maintains effective team member relations.
What your background should be
- Three or more years of clinical nursing experience and two years or more utilization management experience; and at least one year of healthcare supervisory experience required. Active, unrestricted state registered nursing license in good standing required. Three or more years in a supervisory role in a managed care environment preferred. Utilization management certification (CPHM), certified professional in health care quality (CPHQ), or other healthcare, or management certification preferred. Skilled at supervising high functioning multidisciplinary teams; able to use effective management principles; excellent organizational skills with the ability to manage multiple priorities; work independently and handle multiple projects simultaneously; knowledge of applicable state, and federal regulations; experience with NCQA; ability to take initiative and see tasks to completion; computer literate (Microsoft Office products). Excellent verbal and written communication skills; skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.
Required Schooling / Training
- Bachelor degree in nursing or related field or equivalent is required; master degree in nursing or related field preferred.
Who is the client company
- Concern about healthcare services.
- If you are interested in this position, send your resume to firstname.lastname@example.org