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.

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.

• 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…