Supervisor of Utilization Management​/CM

The Supervisor provides day-to-day operational support for Transitional Care and Complex Care Management teams, focusing on coordinating work schedules, ensuring policy compliance, and monitoring the quality of care delivered to members. This role supports the implementation of processes designed to improve health outcomes, reduce healthcare utilization costs, and facilitate effective care transitions for complex populations. The Supervisor works closely with the Director/Manager, Shared Services, Medical Center, and other stakeholders to ensure a seamless continuum of care across inpatient, ambulatory, and community-based settings.

As a liaison between staff and management, the Supervisor facilitates communication and supports efficient team operations. Additionally, the Supervisor assists with performance evaluations and handles certain disciplinary actions, collaborating with the Manager/Director to uphold a high standard of service. Success in role is measured by meeting and/or exceeding KPI targets around Admissions/1000, Readmissions/1000, Average length of stay and ED Utilization.

• Supervises Transitional Care Managers/Care Navigators team members, Complex Care Manager Teams
• Assists with staff development and ensure adherence to care management and Transitional Care Management standards, including person-centered care planning and documentation protocols.
• Ensures Huddle Meetings are effective, efficient and engaging, focusing on identification of member risks, actions to be taken to mitigate risks and closing the loop. Conducts member assessment and care plans audits, one-on-one coaching/training to maintain quality and compliance with regulatory standards, and policies and procedures.
• Supports team members with caseload management to ensure timely documentation and adherence to organizational and health plan requirements.
• Assists with Interviewing, hiring new clinical team staff, and conducts regular 1:1 meetings and performance reviews to optimize performance
• Assists with Prioritization of members and focus for the team
• Provides timely training and meeting updates then ensures team member understand an incorporate changes are into their work
• Fosters strong teamwork among the teams and a culture of accountability to members and each other
• Reviews program KPIs with team members and if performance is on track, celebrates wins, if performance is not on track, initiates root cause analyses and corrective action plans as needed.

• Facilitates coordination with community organizations, primary care providers, and specialists to address members' chronic care needs and facilitate smooth transitions of care.
• Partners with inpatient case management for collaborative discharge planning.
• Assists in hosting and documenting interdisciplinary care team (ICT) meetings to support effective member outcomes.

• Utilizes data and reporting to monitor team performance and identify opportunities for improvement in health outcomes and member satisfaction.
• Uses professional develop plans as a coach document as needed to enhance a tema members’ performance
• Work closely with the manager to implement performance improvement plans for staff as needed.

• Act as a resource and support for team members in managing complex cases, addressing members' medical, behavioral, and socioeconomic needs through best practices and therapeutic approaches.

• Supports the manager/director in maintaining relationships with payors, community organizations, and facility leadership to address barriers such as housing, food security, and financial instability.
• Works collaboratively with MET and Medical Director to optimize member outcomes

• Assist the manager in onboarding, training, and development for new team members. Play a key role in Chapters 3 and 4 onboarding for new hires.

• Support team meetings and contribute to building team morale and productivity.

• Ensure the privacy and security of member information in compliance with organizational and legal standards.

• Support flexible and innovative solutions to meet changing business needs and priorities.

• Will participate in national meetings focused on how Lead positions function within the organization.

• Will need to be a true subject matter expert in our EHR/EMR…