Apply on Employer Site

Hill Physicians Medical Group · 1 day ago

Supervisor, Utilization Management – Authorizations (Hybrid, Remote Considered) - 26-05

Sacramento, CA

Full-time

Hybrid

Mid, Senior Level

$106K/yr - $135K/yr

5+ years exp

Hill Physicians Medical Group is shaping the healthcare of the future by actively managing care that prevents disease and supports those with chronic conditions. They are seeking a Supervisor for Utilization Management who will provide clinical guidance and supervise the daily workflow for Authorizations, ensuring appropriate utilization of services and outcomes.

Health CareMedicalProfessional Services

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

Qualification

California RN LicensureUtilization ManagementSupervisory ExperienceClinical Nursing ExperienceMS Office ProficiencyLeadership SkillsOrganizational SkillsCommunication SkillsComputer SkillsEpic/Tapestry Experience

Required

Active, unrestricted California Licensure: Registered Nurse (RN) preferred

Minimum three years clinical nursing experience

Minimum two years utilization management experience, preferably in managed care

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