Supervisor, Utilization Management Prior Authorization Program

TRIA Orthopedics•Bloomington, MN

About The Position

HealthPartners is hiring a Supervisor, Utilization Management Prior Authorization Program. This position exists to provide supervision to, and performance management of, clinical review staff in alignment with HealthPartners leadership characteristics. POSITION PURPOSE: Provide supervision to, and performance management of, clinical review staff in alignment with HealthPartners leadership characteristics. To ensure optimal performance on utilization review performance metrics including accuracy, completeness, timeliness, compliance and optimal integration with other HealthPartners departments To pursue and implement strategies to improve productivity, efficiency and employee satisfaction To pursue and implement strategies to improve member and provider satisfaction including strategies to reduce turn around times To provide day-to-day operational support, direction and leadership to staff, including problem solving.

Requirements

Currently licensed Registered Nurse with Bachelor’s degree or currently licensed RN with 3-5 years of supervisory/management experience.
Three to five years hospital experience.
Two years experience with prior authorization process and associated regulatory and accreditation compliance requirements
Excellent team building skills.
Excellent leadership and supervisory skills
Demonstrated experience with development and documentation of work flows and processes.
Demonstrated skill in effective use and management of medical management systems and software.
High level of expertise in written, oral, and interpersonal communication.
Ability to plan, organize and prioritize work effectively, including the flexibility to accommodate frequent changes.
Demonstrated appropriate decision making under challenging situations.
Excellent time management, prioritization and organization skills.

Nice To Haves

One to two years previous supervisory/management experience
Previous training/orientation experience
Bachelor’s degree in healthcare, business or related field.

Responsibilities

Effectively manages non-union direct reports, including hiring, training, terminations and performance reviews and professional development.
Assists staff with difficult or complex cases.
Coordinates and directs the work flow processes to ensure that customer needs and compliance requirements are met.
Maintains an understanding of state and federal regulations, accreditation standards, HealthPartners products and networks, member contracts and Health Plan policies and procedures related to Utilization Review
Maintains a working knowledge of Medical Policy, Behavioral Health (Health Plan) and Case Management Processes and workflows.
Provides leadership, documentation and coordination for cross-functional (interdepartmental) teams as needed to resolve issues.
Evaluates current processes and systems workflow to identify inefficiencies, needs and opportunities for improvement. Recommends and implements changes to ensure quality, compliance and efficiency of processes.
Assists with data analysis and interpretation in order to identify and address data quality issues when they arise. Suggests alternate reporting strategies as appropriate.
Initiates development and utilization of daily operational reports to monitor staff productivity and compliance with processes.
Works with Manager to ensure implementation of new processes and initiatives in a timely and effective manner.
Participates in and/or effectively leads various committees, workgroups, and projects as needed and assigned.
Promotes a positive, effective and efficient work environment and cross-functional team approach.
Actively participates in activities related to All Employee Survey results
Participates in the creation and updating of Business Continuity and Disaster Recovery plans.
Ensures all staff, processes and programs are customer-focused, resulting in high levels of customer, member/patient/family, colleague and team member satisfaction.
Serve as point of contact and coordinator of issues related to utilization management. This includes interaction with many internal departments including Medical Policy, BH, Case Management, Claims, Government Programs and Member Services, as well as external customers including providers, facilities, nursing home staff, clinic staff, medical records and business offices.
Establishes and maintains good working relationships within UM department, with other HealthPartners departments, and with external customers to facilitate excellence in processes and outcomes.
Creates and maintains a cohesive team by facilitating a collaborative, respectful, diverse environment.
Selects, trains, develops and motivates a competent work force.
Builds effective relationships, and inspires staff to achieve excellence in the daily operations.
Embraces change. Creates an environment that encourages creativity, independence, and willingness to change.
Monitors for education/training needs. Once identified, facilitates implementation of training sessions.
Provides supervision, guidance, coaching, and development of staff.
Provides ongoing performance feedback to staff members, and completes annual reviews on a timely basis.
Monitors staffing and recommends adjustments to Manager as needed.
Promotes staff development in assignment of special projects, ongoing independent study, and education-related activities, to maintain and increase knowledge in the areas of responsibility.
Communicates with other team leaders, Systems Support Team and individual staff members to facilitate successful daily operations.
Maintains confidentiality of information in accordance with department and corporate policies.
Assists in development of policies and procedures to meet health plan, departmental, regulatory and accreditation requirements.
Provides routine updates on team status, including productivity, issues and outcomes to Managers.
Collaborates with, and acts as a resource to, internal and external customers on HealthPartners Prior Authoriozation Program processes, goals and functions.
Maintains knowledge of and effectively uses automated applications and systems.
Implements strategies to ensure efficiency and productivity through proficient use of automated system.
Review and edit documentation related to new programs and software for medical management, including on-line help files.
Develop and maintain effective manuals and systems tools to be used for orientation, training and as ongoing resources.
Serve as a Super User for select medical management applications. This may include participation in system design, system testing, system training, identifying and requesting system enhancements and day to day troubleshooting.
Participates in ongoing independent study, education-related professional activities, and professional affiliations to maintain and increase knowledge in the areas of Utilization review and Inpatient Notifications.
Participate in ongoing independent study and education to develop and maintain knowledge in the areas of applicable software systems, regulatory and accreditation standards.
Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for personal growth and development.
Consistently applies HealthPartners organizational and department values (missions/ vision / initiatives), values and continuous quality improvement principles in relationships, daily work, and program supervision.
Participate in the creation and updating of Business Continuity and Disaster Recovery plans
Participates in various committees, task forces, projects, and quality improvement teams, as needed and assigned.
Performs other duties as assigned.