UM Supervisor Clinical Ops

We are searching for a Supervisor UM Clinical Operations.  Someone who will supervise front line staff by directing the activities for the team. Provides oversight of UM processes to ensure efficient and appropriate use of healthcare resources. Handles provider and member concerns and issues that require a high degree of appropriate knowledge, creativity, research and communication with internal and external resources. To assist with the management of prospective, concurrent and retrospective authorization requests. To ensure resources are utilized efficiently, in accordance with program objectives, key performance indicators and in ways that consistently promote provider and member quality and satisfaction. To lessen the probability of c complaints by managing problems referred by Member/Provider Service Representatives or other staff. 

Think you've got what it takes?

Qualifications:

• Bachelor's Degree required
• RN - Lic-Registered Nurses Texas Board of Nursing or Nurse Licensure Compact required
• 2 years Managed care experience required
• 2 years Utilization Management or healthcare administration required

Responsibilities:

• Supports Utilization Management daily operations for medical and behavioral health
• Conducts initial and on-going training for Utilization Management staff.
• Participates in quality initiatives and performance management.
• Supervision of daily operations
• Performs edits in timekeeping system (enters missed punches when appropriate, enters PTO and EIB hours). 
• Monitors timekeeping system to ensure adherence to punctuality and attendance expectations in strict accordance departmental policies and procedures as measured by timekeeping reports and other performance and productivity metrics. 
• Participates in daily operations meeting, staff meetings and other leadership meetings as requested. 
• Participates in interviewing and evaluating applicants and makes employment recommendations as requested by leader. 
• Participates in the preparation and delivery of staff performance management plans (PMP). 
• Performs other duties consistent with this job description as assigned.