Utilization Management Supervisor

Responsibilities Position Summary : The Utilization Management Supervisor is responsible for planning, organizing, and managing daily operations of the Utilization Management team.

The Supervisor duties include but are not limited to ensuring positive communication amongst treatment team members, modeling Service Excellence Standards, providing on-site education to manage difficult cases, and assisting the Director of Utilization Management with department processes and procedures.

Key Responsibilities : Maintains knowledge of all facets of Utilization Management Supports Director and performs management duties when Director is out of office.

Communicates department and company goals and deadlines to team. Develops process implementation, process flow, process evaluation, and process improvement.

Keeps management updated on team performance. Supervise PTO, outages, and Kronos. Assesses training needs, opportunities for coaching and process improvement.

Creates an inspiring team environment with an open communication and motivation culture. Reviews staff productivity reports and follows up as appropriate.

Assists Director of Utilization Management during the month end process including compilation of denials, appeals, minor causes, payers and analysis of various reports.

Collaborates with Admissions, Business Office, and Health Information Management about insurance benefits eligibility, and pre-cert for all potential patients of Laurel Ridge both on-site and off-site.

Follow-up and analyze all authorizations on an ongoing basis in order to reduce denials. Prepares Daily / Monthly Reports as requested.

Qualifications Skills, Knowledge, and Abilities : Demonstrated knowledge and understanding of Managed Care, Commercial and State Agency policies and requirements.

Ability to analyze data and workflow in order to develop process improvement initiatives. Ability to solve complex problems and issues in a timely manner.

Service Excellence Standards and exceptional customer services skills. Proficient in Word, Excel, and other office equipment (multi-line phone, fax machine) Ability to make quality decisions utilizing good judgement in demanding situations.

Ability to multi-task and prioritize while meeting strict deadlines. Effective communication skills. Effective leadership skills.

Effective organizational skills. Exceptional attention to detail. Education : High School Diploma or GED LVN, RN, LPC, LMSW or Bachelors Degree in Health Care Administration preferred Licensure Certification : Preferred but not required Experience : Minimum two years experience in a mental health setting with previous experience in Utilization Management / Care Management Previous leadership experience preferred Physical Requirements : Requires prolonged sitting and repetitive use of hands for typing and writing.

Constant use of telephone and computer (approximately 5-8 hours daily). Must be able to spend 30% to 40% of time standing or walking between units.

60% to 70% of time is spent sitting at a desk. Hearing and vision sufficient to perform essential functions. Ability to work under stress on a daily basis.

Ability to lift up to 25 pounds and occasional bending, stooping, kneeling, and grasping. Ability to maintain confidentiality.

Ability to speak and write clearly.