Utilization Management Supervisor; Hybrid

The Supervisor, Utilization Management supervises the daily operations of the Utilization Management (UM) department to ensure the appropriate coordination of health care services and compliance with Utilization Review (UR) policies and procedures, as well as, regulatory and Care First's accreditation standards. We are looking for an experienced professional in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model.

The incumbent will be expected to work a portion of their week from home and a portion of their week at a Care First location based on business needs and work activities/deliverables that week.

The Supervisor, Utilization Management supervises the daily operations of the Utilization Management (UM) department to ensure the appropriate coordination of health care services and compliance with Utilization Review (UR) policies and procedures, as well as, regulatory and Care First's accreditation standards. We are looking for an experienced professional in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model.

The incumbent will be expected to work a portion of their week from home and a portion of their week at a Care First location based on business needs and work activities/deliverables that week.

• Supervises the daily operations of UM staff. Recruits, retains and develops a high performing team. Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures. Ensures appropriate usage of resources in order to facilitate the UM process. Educates staff as necessary to ensure consistent performance and adherence to standards.
• Ensures compliance within applicable state program guidelines. Evaluates compliance policies and procedures and analyzes/recommends enhancements.
• Facilitates the collection and validation of data from UM staff to ensure consistency and accuracy. Assists in analyzing and reporting data used to support the achievement of corporate objectives, enhance operational monitoring and meet external reporting requirements.
• Evaluates departmental processes and recommends improvement opportunities to enhance operational efficiency and support departmental objectives.
• Provides timely communication to management regarding department operations including customer and case-related issues, operational trends, variances, reporting outcomes, action plans, etc., to support informed decision-making.

This position manages people.

Education Level: Bachelor's Degree in Nursing OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 3 years Medical/surgical experience including, but not limited to, inpatient care, outpatient/home care and hospice care, and experience reviewing patient medical care with demonstrated leadership.

Licenses/Certifications Required Upon Hire: RN
- Registered Nurse
- State Licensure And/or Compact State Licensure

• Excellent analytical, problem-solving skills with ability to judge appropriateness of member services and treatments on a case by case basis.
• Ability to multitask, prioritize and maintain a dynamic personal organization system that allows for flexibility.
• Knowledge of accreditation standards and federal/state regulations and general principles relating to utilization review.
• Effective written and interpersonal communication skills to engage with members, healthcare professionals, and internal colleagues.
• Computer skills, including Microsoft Office programs.
• Ability to mentor and coach associates…