Supervisor, Utilization Management (RN)

What you will get to do:

Medica's Utilization Management (UM) Supervisor is responsible for the day to day operational support and strategic activities of the assigned team. The leader in this role will be accountable for achieving department objectives and maintaining flexibility to meet business needs.

Responsibilities include:

* Supervision of the clinical staff, including coaching and staff development, recruiting, hiring and training team members, and ensuring that the strategic and business processes are established, maintained and communicated and effective interdepartmental communications are established.

* Manage team members work load and monitor staffing ratios.

* Build and maintain strong relationships with internal and external partners. More specifically, support the Manager, Utilization Management in relationship building within Medica and its vendor partners to help prioritize, integrate and coordinate interventions for population segments based on medical, behavioral and social needs.

* Oversee UM projects, initiates and participates in quality improvement activities, and performs data monitoring of utilization activity for reporting to internal customers.

* Audit team members for compliance against policies and procedures and NCQA audit requirements.

* Provide support to Manager to run monthly reports for business segments and leadership on key performance targets including, productivity, closure of gaps in service, outcomes, satisfaction surveys and quality indicators.

Our UM Supervisor will support the manager and work with staff to integrate and understand accreditation requirements, and incorporate them into department activities. This Supervisor will also conduct job functions in a manner which consistently promotes a high level of customer service to both internal and external customers, and models and supports the company's core values and basic principles. This includes but is not limited to maintaining constructive and professional relationships with peers, supervisory personnel and internal and external customers, facilitating change and serving as a role model, and proactively meeting customer's needs in a timely fashion.


* Bachelor's degree in Nursing

* 5 years of related experience including Utilization Management and leadership experience; direct supervisory or management experience strongly preferred

* 3 years of experience and expertise in communicating with staff in different positions and all levels of management positions

* Health Plan experience preferred

Skills & Abilities:

* Excellent customer service skills and proven team building skills.

* Excellent computer skills including Microsoft Word, Outlook, Power Point and Excel

* High degree of initiative and ability to work independently, and within a group.

* Demonstrated effective project management skills, including use of project planning and tracking tools; development of achievable goals, objectives, and timelines; and innovative use of resources.

* Ability to plan, organize and prioritize work effectively, including the flexibility to accommodate frequent changes.

* Strong problem solving skills.

* Knowledge of NCQA, Motivational Interviewing, Evidence Based Medicine and coaching

* Consultant skills to articulate business needs and translate to quality programs that result in targeted staff competencies.

* Strong leadership skills


* Unrestricted Minnesota RN License

Equal Opportunity Employer Including Veterans & Disabled Individuals