Supervisor, Utilization Management RN– Authorizations - 26-107

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At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

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Hill Physicians has much to offer prospective employees.  We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Provide clinical guidance, supervise and monitor the daily work flow for Authorizations within Health Resources Management (HRM) with focus on appropriate utilization of services and appropriate outcomes.  

Key Tasks and Responsibilities:

• Provide clinical expertise, guidance and supervision to the Authorizations staff including clinical and non-clinical staff. Lead by example and act as a resource to staff by resolving clinical and benefit issues.
• Manage staff production and overall inventory to ensure turnaround times are meeting department and regulatory goals
• Manage the prospective, concurrent and retrospective review process to ensure performance and regulatory standards are met.
• Research, file preparation and readiness for health plan audits
• Assist in setting and achieving unit and department goals/standards consistent with business objectives.
• Monitor productivity and other metrics to ensure turnaround times, working oldest authorizations first and other goals are met
• Support implementation of department policies and procedures.
• Participate in recruitment, retention of staff, and training.
• Support a positive work environment, motivating staff and fostering teamwork.
• Evaluate employee performance and provide appropriate feedback.
• Serve as a resource for physicians, providers, members and staff.
• Meet with staff, communicate and receive feedback on operational issues.
• Communicate and reinforce department policy and procedures.  Participate in annual review and revision while collaborating with other regions to ensure consistency in application.
• Share accountability for managing the department budget and ensuring appropriateness of expenditures such as supplies and overtime.
• Process authorization approvals and denial letters as needed.
• Other duties as assigned.

Skills and Experience:

• Active, unrestricted California Licensure:  Registered Nurse (RN) preferred
• Minimum three years clinical nursing experience.
• Minimum two years utilization management experience, preferably in managed care.
• Supervisory experience and/or demonstrated leadership skills preferred.
• Strong leadership, organizational, and communications skills.
• Ability to work effectively with a variety of customers including physicians, managers, providers, office staff, health plans and internal staff members.
• Proficient in MS office applications.
• Strong computer skills for application implementation and monitoring as well as mentoring staff on these applications.
• Experience with Epic/Tapestry preferred.

Additional Information

Salary: $108,000 - $138,000 Annual

Hill Physicians is an Equal Opportunity Employer