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Boston, Massachusetts
Posted: 25-Jan-25
Location: Dallas, Texas
Categories:
Internal Number: 25001452
JOB SUMMARY
The Supervisor Utilization Review RN is accountable for daily oversight of the Utilization Review (UR) function, and provides direction for complex cases, monitors pending cases, reviews and gives feedback to trainers regarding staff education opportunities, and acts as a liaison with interdepartmental communication.
ESSENTIAL FUNCTIONS OF THE ROLE
- Functions as a working Supervisor for Utilization Review Department, through the monitoring of staff workload, creating assignments, reviewing productivity, conducting quality reviews, advising with peer-to-peer appeals, and advising with denial research.
- Compiles data for productivity reports on a weekly basis to help staffing outcomes and quality metrics.
- Partner with Care Coordination Medical Director on patients not meeting criteria and informs Clinical Resource Manager/Director as needed.
- Completes daily staff assignments to ensure adequate service levels
- Monitors daily observation report and identify any potential issues
- Resolves escalations received from UR Nurses and staff
- Conducts quality reviews as assigned
- Responds to UR questions from staff and stakeholders
- Serves as a Subject Matter Expert' (SME) for UR workflow issues, complex cases, denials and internal/external customers
KEY SUCCESS FACTORS
- Ability to assist people in recognizing and solving problems.
- Ability to supervise, motivate, and provide guidance to staff to ensure their clinical proficiency.
- Excellent written and verbal communication skills.
- Ability to work effectively with employees at all levels within the organization, including physician and executive leadership.
- Knowledge of discharge planning, case management and utilization review.
- Ability to make tactical steps around the allocation and direction of the work of supervised employees using established guidelines, policies and/or procedures.
- Ability to make effective hiring and termination recommendations.
- Ability to train, and evaluate performance of supervised staff.
- General computer skills, including but not limited to: Microsoft Office, information security, scheduling and payroll systems, electronic medical documentation, and email.
BENEFITS
Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level
QUALIFICATIONS
- EDUCATION - Associate's
- MAJOR - Nursing
- EXPERIENCE - 4 Years of Experience
