Supervisor, Utilization Management - Operations

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 and strategic activities of the
 assigned review coordinator team. This position is also accountable for
 achieving results and maintaining flexibility to meet business needs.
 Responsibilities include the supervision of team members, ensuring that
 strategic processes are established, communicated and accomplished, and
 facilitating interdepartmental communications. This position resides in Health
 Management yet interacts regularly with other business segments within Medica.
 This position assists in developing, maintaining, executing, and overseeing of
 end-to-end operational processes for triage and processing of all
 provider-related submissions and questions related to inpatient notification and
 discharge information and prior authorizations. In addition, this position is
 responsible for process documentation and implementation, facilitating process
 improvement opportunities, and on-going maintenance of departmental processes.

 The Supervisor, Utilization Management - Ops oversees a team of Review
 Coordinators who serve as a central point of contact for operational issue
 identification, escalation, and resolution. This role drives operational
 excellence by identifying and implementing process improvements across
 Utilization Management and related departments, coordinating cross-functional
 initiatives, and ensuring resources are aligned to support business objectives.
 The Supervisor plays a key role in the development, planning, and execution of
 departmental and enterprise projects that support Utilization Management
 operations.

 The Supervisor, Utilization Management - Ops is responsible for the day-to-day
 leadership and performance of the assigned team, ensuring operational goals,
 service standards, and business objectives are achieved. This role establishes
 and communicates strategic priorities, fosters collaboration across departments,
 and supports organizational agility in response to evolving business needs.
 Positioned within Health Management, the Supervisor partners regularly with
 leaders and teams across Medica to drive effective outcomes and continuous
 improvement.

Key Accountabilities:

Supervision-Daily Operations

* Ensures workflow is efficient and effective. Ensures requests are completed
    within department standards and comply with regulatory guidelines.
  
* Identifies and assists in resolution of escalated and/or complex issues.
    Tracks and trends issues and completes root cause analysis
  
* Communicates and implements department/team changes and decisions
  
* Oversees team functions including, but not limited to, timecard approval,
    personal time off reviews, etc.
  
* Facilitates start to end hiring process. Includes interviews, appropriate
    paperwork and onboarding schedule
  
* Maintains accessibility and availability to facilitate problem solving and
    resolution of case reviews and complex issues
  
* Ensures policy and procedures are effectively managed and implemented
  
* Develops new and oversee the monitoring and updating of department SOPs
    (standard operating procedures). Collaborates with team and communicates as
    needed
  
* Demonstrates ability to prioritize and distribute high volume of requests,
    communicates plan to team as needed
  
* Identifies and initiates process improvements
  
* Assists in department process improvement planning, implementation and
    training related to audit findings and Corrective Action Plans
  
* Supports daily operations and long-range planning for department
  
* Collaborates with department and all business segments to ensure consistent,
    effective and timely communication occurs
  
* Works with internal and external stakeholders to ensure accurate system
    set-up and maintenance

 Staff Supervision
- Direct Reports

* Communicates accurate and timely information to team members to enhance the
    effectiveness and efficiency of performance
  
* Encourages staff to identify potential areas for improvement and work
    efficiencies. Identifies streamlining opportunities
  
* Provides technical support by researching and responding timely to complex
    questions and issues
  
* Provides ongoing coaching and development for new and existing team members
    on a regular basis. Assesses and…