Supervisor, Medical UM Health Integrated
THIS JOB HAS EXPIRED Description
Position is based in Tampa, FL (Office) Hours: Monday - Friday, 9:00 am - 6:00 pm
JOB SUMMARY: The Supervisor of UM is a full time position, responsible for assisting the
Sr. Manager of UM and PRS in the day to day management of operational, clinical and functional
support for Medical Utilization Management. The Supervisor (1) supervises staff including
hiring, coaching and completion of performance evaluations. (2) Assists with policy and procedures,
accreditation and regulatory standards. (3) Offers input and works with the appropriate departments to support
the development and launch of new programs; (4) works with clients to deliver quality products and provide
excellent customer service.
Licensed RN with current, unrestricted license required.
Bachelor?s degree preferred in a health science.
Two-three years clinical experience in acute hospital discharges planning required.
Three years full-time direct clinical or critical care to patients in a medical/surgical or behavioral health setting.
5 years experience Utilization Management or other managed care or cost management program with at least 3 of the 5 years in direct supervision of UM required.
At least 5 years Call Center Management experience preferred.
Experience with application of healthcare criteria systems and programs, e.g. Triage, InterQual, Milliman.
Must have previous experience with URAC and or NCQA accreditation process.
Ability to manage and coordinate programs, projects, resources, and staff across multiple company functions;
Strong administrative qualities to analyze goals, products, programs, and processes and make recommendations for changes;
Knowledge of all aspects of the following managed care products: utilization management,
Organizational and project management skills;
Strong computer skills and experience with Microsoft Office;
Strong communication, interpersonal and leadership skills.
Coordinates and manages all Medical Utilization Management programs.
Assure job descriptions and staff roles/responsibilities are accurate and current;
Responsible for supervision and oversight of staff
Supervise the interviewing and hiring of staff for the above programs;
Assure that all regulatory and accreditation standards are implemented and met;
Assure that Policies & Procedures, Operational Guidelines, and process workflows are current meet quality accreditation and regulatory standards, and are communicated to and available for staff on the IntraNet;
Assist the Quality department in the development and evaluation of an annual QI plan for all programs and assures all indicators are met;
Participate in the Quality Committee and assists in related functions;
Analyze all programs to ensure effectiveness, quality, productivity, profitability and patient safety;
Coordinate all programs and work with other Health Integrated Departments and Committees, i.e. Quality Committee, Education, Account Management, etc;
Assist in new product development efforts and assures current products are being delivered as designed;
Assist the Manager in plans for growth;
Provide input and direction to Information Services on systems issues and enhancements;
Offer input and assist with development of orientation, education and training programs
Assure delivery expectations of client contracts are being met;
Ensure clinical staff consult and seek advice from a licensed physician with expertise appropriate to the types of services being managed
Customer Service ? Internal:
Work with manager and staff to develop a high level of morale, positivity, and commitment in the work environment;
Provide strong leadership role model for staff;
Identify problems, issues and/or concerns proactively or as they arise and resolves them as quickly as possible;
Develop strong working relationships with all internal staff members to encourage a cooperative sharing of ideas and support;
Monitor and report any quality of care issues or concerns to Quality Management;
Maintain a courteous and professional attitude when working with all staff members and the management team;
Ensures that licensed health professionals are readily available to answer non-clinical staff questions and shall ensure that non-clinical staff are performing within the scope of the non-clinical role;
Customer Service ? External:
Lead /Support Corporate initiatives as directed
Work, communicate and collaborate in harmony and in a courteous and professional manner with members, practitioners, providers, multidisciplinary health care team members, and clients;
Work collaboratively with the health plan?s management team to assure quality service delivery that meets client expectations; and
Serve as a liaison and patient advocate, when applicable, for quality of care and cost outcomes.
Lead /Support Corporate initiatives as directed
Direct and /or Assist in the investigation and implementation of operational systems
Drive development of policies, procedures and processes that support operations excellence
Set overall strategy and direction for direct reporting business units
Lead, mentor, coach and assess the performance of all direct reports
Relationship build with HI Clients which may involve travel as well as frequent meetings
||10008 North Dale Mabry |
Tampa, FL 33618
THIS JOB HAS EXPIRED