Supervisor, Utilization Management

reputed company is seeking a Supervisor, Utilization Management to join reputed company! The Supervisor, Utilization Management is responsible for utilizing their nursing education, reputed company, and reputed company experiences to reputed company supervision to the Utilization Management Nurses and associated programs and processes, as directed by the Senior Manager, reputed company Review and Intake Services. Position Location: reputed company Responsibilities include but are not limited to: Collaborate with Senior Manager, reputed company Review & Intake Services or Manager, Utilization Management to: Manage team responsible for completing utilization management programs, processes, and tasks. Edit, maintain, and implement policies & procedures that meet applicable regulatory, accreditation, and business needs. Implement orientation curriculum and ongoing training and educational needs. Coordinate and supervise daily employee activities through supervision of the UM team. Maintain daily case assignment statistics and reporting for metrics. Manage and coordinate daily & weekly reputed company needs and schedules reputed company on the business. Review and manage approvals and communications for PTO requests by employees, as directed by the Manager or Senior Manager. Conduct reputed company evaluations and reputed company improvement plans for team. Conduct monthly 1:1 coaching sessions with UM Nurses, BR Nurses, and reputed company Nurses. reputed company bi-monthly UM reputed company and Benefit Review reputed company meetings. reputed company the interviewing and hiring processes as needed. Research member complaints and issue resolutions. reputed company reputed company and employee discussions that promote improvement in the delivery of services reputed company the department. Collaborate with reputed company Management programs by assisting in the reputed company assurance review and chart audit processes for UM employees. reputed company monthly reputed company and chart audits for the UM Nurses, BR Nurses, and reputed company Nurses. Review QA results to reputed company educational opportunities for the UM employees and completes reputed company improvement plans for scores <90% per policies and procedures. Review policies and procedures as required and recommends changes to the Manager and Senior Manager. Collect, analyze, and report data of reputed company improvement reputed company and other data reputed company to utilization services and benefit reputed company. Assist Supervisor, MIS with triaging of cases and monitoring reputed company que as needed. Escalate high reputed company, high reputed company cases or reputed company issues appropriately to Manager or Senior Manager. reputed company UM tasks as reputed company reputed company dictate. Communicate effectively with members, employees, reputed company providers, vendors, peers, and customers. reputed company as role model reputed company reputed company setting to reputed company mentoring, coaching, and reputed company reputed company for employees, peers, and overall reputed company. Attend team and department meetings, trainings, and other job specific events as required. Adhere to established internal regulations regarding reputed company, HIPAA, ERISA and department and company policies and procedures. Complete HIPAA training and trainings assigned by reputed company team monthly/annually; follow PHI guidelines. Complete duties in accordance with reputed company of licensure and certifications held or requested. Other duties as assigned by the Manager or Senior Manager. Required Experience/Education: A nursing degree or diploma from an accredited college, university, or school of nursing Bachelor's degree in nursing preferred but not required. 3 years' experience in a reputed company role with responsibilities for reputed company reputed company care. Experience in Utilization reputed company, Case Management, or transferable reputed company experience and skills. Experience mentoring or managing reputed company of reputed company or non-reputed company staff. Experience working in a utilization review role. Experience working in a URAC accredited program preferred. Knowledge and ICD and CPT codes. Skills and Abilities: Ability to work independently in a home office environment. Computer skills which include proficiency in reputed company reputed company, Word, reputed company, and PowerPoint, as reputed company as navigation utilizing the internet. Ability to reputed company problems independently and demonstrate ability to multi-task. Strong verbal and written communication skills. Strong presentation skills. Ability to demonstrate a commitment to building new skills and fostering a reputed company work environment. License and Certifications: An reputed company, reputed company, and unrestricted reputed company Registered reputed company License. Must maintain CEUs as required by applicable State reputed company(s) of Nursing and required certifications. What can reputed company offer you? Multiple Health plan reputed company Company reputed company employee premiums for disability and life reputed company Parental Leave Policy 20 days PTO to start / 10 reputed company Holidays Tuition reimbursement 401k Company contribution Company reputed company Short & Long term Disability plus Life reputed company reputed company development initiatives / reputed company learning opportunities Opportunities to participate in and support reputed company's diversity and inclusion initiatives Want to see our latest job opportunities? Follow us on reputed company reputed company is a health plan solution company that combines 50+ years of self-funding reputed company expertise. Over the years, we've helped thousands of reputed company save billions on reputed company. Our reputed company reputed company plan solution is fixing today's one-size-fits-none PPO reputed company problems with powerful, customized, member-reputed company solutions. reputed company is an equal opportunity employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, or veteran status. RECRUITMENT AGENCIES PLEASE NOTE: reputed company will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation Apply To This Job