Brighton Health Plan Solutions · 3 hours ago
Supervisor, Utilization Management Support
United States
Full-time
Remote
Mid Level
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Hiring Manager
Paul Pascale
Insider Connection @Brighton Health Plan Solutions
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Responsibilities
Supervises and supports the UM Coordinators’ daily activities.
Provides mentoring and ongoing training of staff to enhance performance.
Manages departmental UM Coordinator activity and ensures appropriate staffing levels and scheduling to meet department KPI’s (Key Performance Indicators).
Collaborates with the clinical team and clinical leadership to address concerns and operational gaps in day-to-day activities.
Supports and mentors the UM Coordinator team. Handles caller escalations and resolves as needed.
Serves as subject matter expert (SME) for non-clinical authorization activities within the utilization management department.
Conducts quality call monitoring audits and case file audits with clinical leadership to coach performance and identify additional training needs.
Provides support to UM Coordinator team through regular monthly coaching sessions and team meetings.
Manages special projects and allocates resources as needed.
Collaborate with Network management team, Account Managers and Sales teams to gather feedback to enhance service performance.
Participate in activities designed to improve member and client satisfaction and business performance.
Works with UM Manager and/or Director to identify performance improvement initiatives and executes strategies accordingly.
Support projects and other departments in completing tasks when directed by management.
Qualification
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Required
HS diploma or GED.
Team leadership experience required.
Strong medical record review skills.
Ability to create staffing schedules and analyze workload volumes.
Basic computer operations knowledge.
Intermediate knowledge of Microsoft Office (Word, Excel, Access, PowerPoint, and Outlook.
Strong time management skills.
Courteous with strong customer service orientation.
Familiarity with medical terminology required.
Preferred
Previous experience in quality monitoring, coaching, counseling, and progressive discipline strongly preferred.
Prior experience in another healthcare plan or third-party payor environments strongly preferred.
Previous knowledge of plan authorization activities and managed care procedures and workflows strongly preferred.
Bachelor’s degree preferred (not required).
Company
Brighton Health Plan Solutions
Brighton Health Plan Solutions is a health care company that specializes in health plan management service.
Founded in 2016
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Jim Cusumano
Co-Founder, President and CEO
Recent News
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