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

In addition to the coaching and staff development responsibilities, the Utilization Management Supervisor must also build strong relationships with internal and external partners. More specifically, support 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 will possess 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. The supervisor will conduct job functions in a manner, which consistently promotes a high level of customer service to both internal and external customers, models and supports the company's core values and basic principles. This includes but is not limited to maintaining constructive and professional relationships with peers, supervisory personnel and internal and external customers, navigating internally and externally, facilitating change and serving as a role model, and proactively meeting customer's needs in a timely fashion.

Performs other duties as assigned.

• Supervise and Maintain Efficient Department Operational Systems/Process
  • Comply with policy and procedures effectively and with appropriate documentation and ensure team meets all department, regulatory and accreditation requirements and goals.
  • Informs 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 is following department guidelines, processes and turn-around times.
  • Manage performance and hold staff accountable for meeting department standards for quality, turn around times, policy application, effectiveness, attendance, and personnel management, etc. Formulate action plan for less than acceptable performance
  • Consult human resources and manager to ensure compliance with company policies and values
  • Responsible for personnel management including interview process, goals establishment, performance review, and team-building
  • Assist with delivery of new employee orientation programs for team members, and contributes 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 standard to monitor staff performance
  • Accountable for driving performance toward goals and communicating effectively to peers when process gaps are impeding goals
  • Develops new and oversee the monitoring and updating of department SOPs (standard operating procedures). Collaborates with team and communicates as needed
• Supervise Performance of Utilization Management Team
  • Leads and supervises 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 improvement plans
  • Provide team members with ongoing and consistent feedback, directed toward clinical excellence and accountability to department goals
  • Regularly assess and measure team workload and staffing…