Supervisor, Utilization Management

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

This position is accountable for the day‑to‑day operational support and strategic activities of the assigned team. It is also accountable for achieving department objectives and maintaining flexibility to meet business needs. Responsibilities include supervision of the clinical staff, ensuring that strategic and business processes are established, maintained and communicated, and establishing effective interdepartmental communications. This position resides in the Health Services department and interacts regularly with other areas within Medica.

In addition to coaching and staff development responsibilities, the Utilization Management Supervisor must also build strong relationships with internal and external partners. The supervisor supports the Manager, Utilization Management in relationship building within Medica and its vendor partners to help prioritize, integrate and coordinate interventions for population segments based on medical, behavioral and social needs.

This role oversees utilization management projects, initiates and participates in quality improvement activities, and performs data monitoring of utilization activity for reporting to internal customers. The Utilization Management Supervisor possesses a strong working knowledge of Medicare and Medicaid regulations, mandates, and compliance standards.

The supervisor will support the manager and work with staff to integrate and understand accreditation requirements, and incorporate them into department activities.

• Supervise and Maintain Efficient Department Operational Systems/Process
  • Comply with policy and procedures effectively and with appropriate documentation and ensure the team meets all department, regulatory and accreditation requirements and goals.
  • Inform the Manager of process, procedure, policy and other issues that cannot be resolved within the team.
  • Model change management philosophies and support and facilitate a positive approach to change among team members.
  • Monitor team members’ calls and casework to ensure staff follows department guidelines, processes and turnaround times.
  • Manage performance and hold staff accountable for meeting department standards for quality, turnaround times, policy application, effectiveness, attendance, and personnel management. Formulate action plans for performance below acceptable levels.
  • Consult human resources and the manager to ensure compliance with company policies and values.
  • Responsible for personnel management including interview process, goal establishment, performance review, and team‑building.
  • Assist with delivery of new employee orientation programs for team members, and contribute to the development, maintenance and communication of educational programs as indicated.
  • Compile and report team and individual statistics for planning and evaluation.
  • Assist the Manager to define and utilize performance standards to monitor staff performance.
  • Accountable for driving performance toward goals and communicating effectively to peers when process gaps impede goals.
  • Develop, monitor and update department SOPs (standard operating procedures). Collaborate with the team and communicate as needed.
• Supervise Performance of Utilization Management Team
  • Lead and supervise the program and team as outlined under the Position Overview section.
  • Assess the training and development needs of each new employee to result in fully competent performance within one year. Assess existing employees for training and development needs or performance…