Overview
Utilization Management Supervisor – Remote Jobs in Boston – Massachusetts – USA at Commonwealth Care Alliance Inc.
Area of Interest
Nursing
Why This Role is Important to Us
Supervisor & The Team Leader reports to the UM Manager. The Team Leader provides management,oversight and mentorship to team members and ensures that Team members are meeting quality and productivity standards. The Team Leader works in closecollaborationwith the manager and Director of the UM team.
What We’re Looking For
Qualifications:
Bachelor’s Degree or equivalent experience, Masters preferred
Registered Nurse (RN) in the State of Mass, preferred
A minimum of 3 years relevant work experience as an RN or equivalent professional experience.
Provenleadershipand management skills with demonstrated ability to work as an effective team member and leader in a complex andfast-paced environment
Excellent interpersonal skills demonstrated by ability to interact professionally with culturally and educationallydiversestaff and patients
Ability to apply clinical and benefit administration guidelines to authorization requests.
Creativity,flexibility, sound judgment, and the ability to work collaboratively and take initiative
Excellent time management, documentation and organizational skills
Strongcommunicationand writing skills
Ability to function effectively as part of amultidisciplinaryclinical team
Must have familiarity with assigned laptop, cell phone, and desktop computer as appropriate, and be proficient – with the use of Word, Outlook, Excel, and SharePoint.
All Locations
What You’ll Be Doing
Provide oversight, supervision, guidance, and management to UM team.
Participates in Team meetings for case review, workflow review and other relevant business related to utilization review process.
Works incollaborationwith the UM Manager to promote cohesive team function with productivity, efficiency,accuracy, and quality medical necessity reviews.
Participate in interviews and hiring decisions, provides input in performance management process (including performance evaluations and disciplinary action), manages time-off requests, and approves time cards and implements policies and procedures.
– Provide high quality comprehensive documentation in the care management platform to reflect the accurate data entry required for the authorization request process to ensure regulatory compliant outcomes.
Interface with clinical team for interpretation of clinical criteria, escalation and general questions.
Reviews quality and productivity metrics and develop plans to address deficiencies or substandard outcomes accordingly
Assist CCA management andleadershipwith the development, refinement and enhancement of utilization management workflows, policies and procedures.
Participate in committees and work groups that promoteclinical excellenceand help to advance CCAs mission and business objectives
Support ClinicalEducationTeam by mentoring new and existing staff and offering teaching opportunities and in services as needed.
Collaborate with IT and CCA management to improve and streamline documentation work-flow as a function of the care management platform.
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Title: Utilization Management Supervisor – Remote
Company: Commonwealth Care Alliance Inc.
Location: Boston – Massachusetts – USA
Category: Healthcare
