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Supervisor, Utilization Management


Supervisor, Utilization Management
Location: Houston, TX
This is a Registered Nurse position
Position Summary
Under the supervision of the Director of Utilization Management, the supervisor is responsible for the daily operations outpatient Utilization Management.

Interacts with Medical Directors, UM department staff and providers to deliver cost effective, quality of care services to Molina members, in accordance with Molina policies, procedures and processes.

Provide administrative and leadership support to staff.
Duties and Responsibilities
* Maintain established referral turnaround times required by NCQA and department policy
* Function as direct supervisor of staff in Outpatient Utilization Management (UM) areas; responsible for daily administrative functions, including staffing, productivity, work quality and focusing on a high level of customer service
* Attend outpatient case review conferences.

Assist in interviewing potential UM staff
* Orient, train and evaluate the work performance of UM staff
* Consult with UM Director to devise and implement corrective action or disciplinary measures necessary to improve staff performance
* Perform timely employee annual evaluations
* Act as both a clinical and administrative resource to UM staff in assessing member needs, devising/implementing plans of care, facilitating UM process and communicating/coordinating UM activities
* Collaborate with and keep the UM Director apprised of operational issues, staffing issues, system and program needs.

Assist with development of UM related programs, and development and evaluation of periodic work plans.

Attend/participate in departmental, company-wide, and external committees, task forces, or work groups, as assigned
* Act as a liaison to both internal and external customers on behalf of both Molina and the UM areas, conducts self in a professional manner at all times
* Maintain cooperative and effective workplace relationships and adhere to company Code of Conduct
* Monitor UM workload for adherence to required turnaround times and deadlines
* Assure oversight and direction of individuals primarily responsible and assure timely completion
* Identify and report under and over utilization issues, delays in service or treatment, and quality of care issues per established policy/procedure
* Perform other duties as assigned
* Comply with required workplace safety standards
Knowledge, Skills and Abilities
* Excellent organizational skill with the ability to manage multiple priorities
* Excellent verbal and written communication skills
* Ability to abide by Molina’s policies
* Maintain regular attendance based on agreed-upon schedule
* Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
* Ability to establish and maintain positive and effective work relationships with coworkers, clients, members
Qualific...

 


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