RN Supervisor, Utilization Management Prior Authorization Program

Overview

Health Partners is hiring an RN Supervisor, Utilization Management Prior Authorization Program. This position exists to provide supervision to, and performance management of, clinical review staff in alignment with Health Partners leadership characteristics.

POSITION PURPOSE
:

Provide supervision to, and performance management of, clinical review staff in alignment with Health Partners leadership characteristics.

• To ensure optimal performance on utilization review performance metrics including accuracy, completeness, timeliness, compliance and optimal integration with other Health Partners departments
• To pursue and implement strategies to improve productivity, efficiency and employee satisfaction
• To pursue and implement strategies to improve member and provider satisfaction including strategies to reduce turn around times
• To provide day-to-day operational support, direction and leadership to staff, including problem solving.

Process Management:

• Effectively manages non-union direct reports, including hiring, training, terminations and performance reviews and professional development.
• Assists staff with difficult or complex cases.
• Coordinates and directs the work flow processes to ensure that customer needs and compliance requirements are met.
• Maintains an understanding of state and federal regulations, accreditation standards, Health Partners products and networks, member contracts and Health Plan policies and procedures related to Utilization Review
• Maintains a working knowledge of Medical Policy, Behavioral Health (Health Plan) and Case Management Processes and workflows.
• Provides leadership, documentation and coordination for cross-functional (interdepartmental) teams as needed to resolve issues.
• Evaluates current processes and systems workflow to identify inefficiencies, needs and opportunities for improvement. Recommends and implements changes to ensure quality, compliance and efficiency of processes.
• Assists with data analysis and interpretation in order to identify and address data quality issues when they arise. Suggests alternate reporting strategies as appropriate.
• Initiates development and utilization of daily operational reports to monitor staff productivity and compliance with processes.
• Works with Manager to ensure implementation of new processes and initiatives in a timely and effective manner.
• Participates in and/or effectively leads various committees, work groups, and projects as needed and assigned.
• Promotes a positive, effective and efficient work environment and cross-functional team approach.
• Actively participates in activities related to All Employee Survey results
• Participates in the creation and updating of Business Continuity and Disaster Recovery plans.

Customer Service:

• Ensures all staff, processes and programs are customer-focused, resulting in high levels of customer, member/patient/family, colleague and team member satisfaction.
• Serve as point of contact and coordinator of issues related to utilization management. This includes interaction with many internal departments including Medical Policy, BH, Case Management, Claims, Government Programs and Member Services, as well as external customers including providers, facilities, nursing home staff, clinic staff, medical records and business offices.

Relationship and Team Building:

• Establishes and maintains good working relationships within UM department, with other Health Partners departments, and with external customers to facilitate excellence in processes and outcomes.
• Creates and maintains a cohesive team by facilitating a collaborative, respectful, diverse environment.

Staff Supervision, Development and Evaluation:

• Selects, trains, develops and motivates a competent work force.
• Builds effective relationships, and inspires staff to achieve excellence in the daily operations.
• Embraces change. Creates an environment that encourages creativity, independence, and willingness to change.
• Monitors for education/training needs. Once identified, facilitates implementation of training sessions.
• Provides supervision, guidance, coaching, and development of staff.
• Provides ongoing performance feedback to staff members, and completes annual reviews on a timely basis.
• Monitors staffing and recommends adjustments to Manager as needed.
• Promotes staff development in assignment of special projects, ongoing independent study, and education-related activities, to maintain and increase knowledge in the areas of responsibility.

Communication:

• Communicates with other team leaders, Systems Support Team and individual staff members to facilitate successful daily operations.
• Maintains confidentiality of information in accordance with department and corporate policies.
• Assists in development of policies and procedures to meet health plan, departmental, regulatory and accreditation requirements.
• Provides routine updates on team status, including productivity, issues and outcomes to Managers.
• Collaborates with, and acts as a resource to, internal and external customers on…