Supervisor, Utilization Management (Clinical - Mostly Remote)

Overview

Supervises and coordinates the day-to-day business operations of clinical and non clinical support activities, including monitoring internal processes, coordinating activities between the clinical and non-clinical staff, and supervising support functions to facilitate efficient clinical operations. Makes recommendations on operational improvements for the department. Works under general supervision.

Compensation:

$93,400.00 - $116,800.00 Annual

• Supervises the day-to-day operations of VNS Health Plans Medical Management clinical and non clinical staff. Makes recommendations to the development, utilization, and evaluation of internal processes to ensure customer satisfaction, efficient operations, and accurate and timely resolution for all complaints and issues. • Monitors workflow procedures and systems for an efficient and timely operation that is responsive to customers (members, discharge planners, VNS Health employees, physicians, families, etc.) and operational needs. Troubleshoots difficult customer service issues, facilitates problem resolution and directs staff in addressing and resolving day-to-day operational issues. • Assists management team in the development of long- and short- range objectives for department, which includes system and operational rollouts and coordination of non clinical support functions to facilitate effective clinical operations. • Provides input to the Education and and Quality department regarding training needs for new initiatives. Participates in the overall planning, implementation and evaluation of such programs. • Works with management to develop and implement strategies and actions to improve the quality of the team’s performance, which includes participation in workflow reengineering, process improvement, risk mitigation and computer application development activities. • Ensures adherence to regulatory and VNS Health Plans standards to ensure compliant operations and department’s readiness for internal and external audits. • Oversees business operations, workflows, utilization and schedules; contributes to systems design and implementation; and participates in developing standards to measure, maintain and maximize efficiencies and meet operational needs. • Performs all duties inherent in a supervisory role. Ensures effective staff training, interviews candidates for employment, evaluates staff performance, and recommends hiring, promotions, salary actions, and terminations as appropriate. • Participates in special projects and performs other duties as assigned.
Qualifications
Licenses and Certifications:
License and current registration to practice as a Registered Professional Nurse in New York State or Licensed Social Worker Required

Education:
Bachelor's Degree in Nursing or other health related degree for RNs Required Master's Degree in Social Work for LSW Required

Work Experience:
Minimum three years progressive customer service or business operations experience, preferably in a health care environment. Required Supervisory experience Preferred Proficient in Personal Computers applications, including Microsoft Word and Excel Required Knowledge of medical terminology, pharmacology information and /or insurance terminology Required Strong knowledge of operations of manual and automated office systems and procedures Required Strong knowledge of third party payer requirement for reimbursement Preferred Strong operational skills with attention to detail Required