Centers Plan for Healthy Living

  • Utilization Management RN Supervisor (Margate, FL)

    Job Locations US-FL-Margate
    Posted Date 2 months ago(1/11/2019 2:40 PM)
    ID
    2019-1379
    # of Openings
    1
  • Overview

    New CPHL Logo

     

     

     

    JOB SUMMARY:

     

    The Utilization Management Supervisor oversees the authorization of covered services for eligible members in CPHL.

     

    Responsibilities

    PRIMARY RESPONSIBILITIES:

     

    • Responsible for effective communication and administration of company policies and procedures and ensuring compliance with these policies, as well as State and Federal regulations
    • Hires, supervises and manages a team of nursing professionals
    • Directs and oversees the implementation and daily activities of  CPHL’s utilization  management program for MLTC members to ensure protocols are being followed
    • Assists in orientation of new staff members
    • Completes regular chart audits to assess the quality of documentation and provides feedback to staff members on areas for improvement
    • Assess timelines of authorization to ensure protocols are met
    • Conducts Interrater Reliability measurement to ensure appropriate protocols are consistently followed.
    • Educates employees on performance standards and ensures employees are meeting these standards
    • Troubleshoots any issues that utilization management staff are experiencing during the authorization process.
    • Assists with integration of new departmental and personnel electronic systems
    • Participates in quality improvement activities
    • Conducts ongoing staff trainings to enhance and update staff’s knowledge and skills
    • Conducts routine meetings with staff to address issues, concerns and communicate status of performance and goals
    • Runs case round meetings with staff
    • Oversees staff production measures
    • Develops and implements an assignment schedule
    • Oversees attendance and scheduling of staff
    • Performs annual reviews of staff
    • Participates in company meetings as requested
    • Communicates regularly with the Manager/Director of Utilization Management regarding staff, outcomes, challenges and all other essential issues
    • Other duties as assigned

    Qualifications

    Education and Experience:

     

    Type of Experience                                          

     

    Required:   

    Active and unrestricted RN license

    Minimum 2 years MLTC experience

    Minimum 2 years management experience

    Minimum 2 years’ experience in authorization of services

    Strong written and verbal communication skills

    Ability to travel within assigned area

     

    Preferred: 

    Bachelor of Science in Nursing , CCM certification

     

     

     

    Preferred: 

    Experience working within a managed care environment

     

    Specific Technical Skills

    Preferred:    Computer proficiency

     

     

     

    SCOPE INFORMATION

    # Direct Reports:         10-15              

               

     

    Physical Requirements:

    The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

     

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    The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification.  They should not be construed as an exhaustive list of all responsibilities, duties and skills required.

     

     

     

     

     

     

     

     

     

     

     

     

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