Utilization Management Supervisor - Remote

Why This Role is Important to Us:

Supervisor & The Team Leader reports to the UM Manager. The Team Leader provides management,oversight and mentorship to team members and ensures that Team members are meeting quality and productivity standards. The Team Leader works in close collaboration with the manager and Director of the UM team.

What You'll Be Doing:

• Provide oversight, supervision, guidance, and management to UM team.

• Participates in Team meetings for case review, workflow review and other relevant business related to utilization review process.

• Works in collaboration with the UM Manager to promote cohesive team function with productivity, efficiency,accuracy, and quality medical necessity reviews.

• Participate in interviews and hiring decisions, provides input in performance management process (including performance evaluations and disciplinary action), manages time-off requests, and approves time cards and implements policies and procedures. - Provide high quality comprehensive documentation in the care management platform to reflect the accurate data entry required for the authorization request process to ensure regulatory compliant outcomes.

• Interface with clinical team for interpretation of clinical criteria, escalation and general questions.

• Reviews quality and productivity metrics and develop plans to address deficiencies or substandard outcomes accordingly

• Assist CCA management and leadership with the development, refinement and enhancement of utilization management workflows, policies and procedures.

• Participate in committees and workgroups that promote clinical excellence and help to advance CCAs mission and business objectives

• Support Clinical Education Team by mentoring new and existing staff and offering teaching opportunities and in services as needed.

• Collaborate with IT and CCA management to improve and streamline documentation work-flow as a function of the care management platform.

What We're Looking For:

Qualifications

• Bachelor's Degree or equivalent experience, Masters preferred

• Registered Nurse (RN) in the State of Mass, preferred

• A minimum of 3 years relevant work experience as an RN or equivalent professional experience.

• Management experience highly desired

• Proven leadership and management skills with demonstrated ability to work as an effective team member and leader in a complex and fast-paced environment

• Excellent interpersonal skills demonstrated by ability to interact professionally with culturally and educationally diverse staff and patients

• Ability to apply clinical and benefit administration guidelines to authorization requests.

• Creativity, flexibility, sound judgment, and the ability to work collaboratively and take initiative

• Excellent time management, documentation and organizational skills

• Strong communication and writing skills

• Ability to function effectively as part of a multidisciplinary clinical team

• Must have familiarity with assigned laptop, cell phone, and desktop computer as appropriate, and be proficient - with the use of Word, Outlook, Excel, and SharePoint.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.