Utilization Management Supervisor - RN

<strong>Working at Advantasure is more than a job &mdash; you&rsquo;re part of a team that is becoming the country&rsquo;s leading healthcare solutions provider.<br /></strong><br /><strong>A career at Advantasure means you&rsquo;ll be part of one of the most dynamic, diversified and innovative healthcare companies in the nation. You&rsquo;ll be helping our clients make their members healthier &mdash; and our communities a better place to call home.</strong>

Glen Allen, USA


<p class="p1"><strong>At Advantasure, we partner with healthcare clients to simplify their operations and accelerate their business success. Powered by our broad expertise and a comprehensive suite of product and service solutions, we help health plans effectively navigate the complexity of healthcare.</strong></p> https://advantasure.com/

keywords: job description,support,compliance,performance,direction exercised,education & experience,skills


Competitive Compensation and Benefits Package

Overview: <br />Responsible for planning, coordinating, and supervising the utilization management department's daily clinical processes. Ensures efficient and cost-effective delivery of quality healthcare in accordance with established corporate and departmental policies and procedures.<br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in the home or office setting with no unusual hazards.&nbsp;</p>
Responsibilities: <br /> <ul> <li>Supervise and provide leadership for an RN clinical team for the delivery of high-quality healthcare services for Medicare Advantage members.</li> <li>Support RN clinical team with daily utilization management operations to include daily assignments, monitor work volume, monitor quality, and plan strategic changes in assigned areas to optimize technologies and personnel.</li> <li>Recommend and assist with complex decision-making and appropriateness within established evidenced-based criteria sets.</li> <li>Ensure compliance with CMS guidelines and evaluate compliance with policies and procedures; recommend and/or initiate process improvements to resolve issues.</li> <li>Encourage, promote, and develop team education and learning opportunities and resources.</li> <li>Administer and adhere to corporate and departmental policies, procedures, and internal processes.</li> <li>Prepare reports, monitor work processes and workflow, inventories, and trends as required to identify utilization management issues and opportunities.</li> <li>Support non-clinical staff as needed in relation to departmental clinical work processes.</li> <li>Support and assist Manager, Managing Director, and Medical Directors as needed with Utilization Management department management activities.</li> <li>Performs other duties as assigned.</li> </ul> <p>&nbsp;</p> <p><strong>DIRECTION EXERCISED:</strong></p> <ul> <li>Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws.&nbsp;</li> <li>Responsibilities include but are not limited to effectively interviewing, hiring, training, and terminating employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.</li> </ul>
Requirements: <br /> <p><strong>EDUCATION:</strong></p> <ul> <li>Associate's Degree in Nursing or RN Diploma required.&nbsp;</li> <li>Bachelor's Degree preferred.&nbsp;</li> <li>Registered Nurse with current unrestricted state of Virginia license required.&nbsp;</li> <li>Certification or progress toward certification is highly preferred and encouraged.</li> </ul> <p>&nbsp;</p> <p><strong>EXPERIENCE:</strong></p> <ul> <li>Three (3) to six (6) years clinical experience and two (2) years supervisory experience leading teams or projects demonstrating progressive experience.</li> </ul> <p>&nbsp;</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Excellent interpersonal skills and the ability to deliver excellent customer service to internal and external customers.</li> <li>Strong organizational skills, flexibility, ability to prioritize competing priorities in a fast-paced environment.</li> <li>Knowledge of managed care processes; experience with applying evidenced-based criteria to provider requests and coordinating health insurance benefits.</li> <li>Proficient with Microsoft Office Products and knowledge of medical management software systems including claims systems.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul>