Utilization Review Management Supervisor
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for�clients while maximizing their career possibilities.� We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment.� We are proud to have been voted the Best TPA in America for 2005 and 2006, and�the first and only Third Party Administrator to receive the coveted Employer of Choice� designation.� Come be a part of our team and 'Claim Your Future.'
PRIMARY PURPOSE:� To provide services for dedicated accounts; to ensure the efficient, cost effective, and high quality delivery of utilization review service by supervising and training a staff of registered nurses; to oversee the management of medical cases worked by registered nurses; to oversee individual and overall results/outcomes of all cases within their scope of responsibilities; and to ensure customer satisfaction through the provision of cost effective and high quality utilization review service that meets their needs.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES:
- Trains and develops utilization review staff.
- Supervises a team of nurses ensuring utilization management services are delivered promptly, cost effectively, courteously, and according to legal requirements, operational, and quality assurance standards.
- Takes corrective action when necessary ensuring objectives, standards, policies and procedures are met.
- Works with program manager to establish and ensure achievement of office/unit customer service, utilization patterns, productivity, quality and financial goals.
- Ensures that staff adheres to quality assurance and productivity standards: assists program manager in evaluating customer service utilization patterns, productivity, quality and financial results ensuring that service delivery is within parameters defined by the company.
- Performs active customer service function for account; provides day-to-day contact with customer to resolve service delivery problems/issues; responds to customer requests; communicates any special customer instruction or procedure that must be adhered to by the registered nurse.
- Advises staff of any pertinent changes in customer service delivery, regulatory mandates or business functions; provides training on regulatory issues.
- Makes recommendation for ongoing and future service delivery options; identifies referrals for case management.
- Maintains a quality assurance program to support the Total Performance Management initiative and the delivery of quality claims service consistently.
SUPERVISORY RESPONSIBILITIES:
- Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
- Interviews, hires and establishes colleague performance development plans; conducts colleague performance reviews.
- Provides support, guidance, leadership and motivation to promote maximum performance.
QUALIFICATIONS:
Education & Licensing:
Baccalaureate degree from an accredited college or university preferred.� RN license required. CPUR or other related designation required.
Experience:
Five (5) years of clinical practice experience including two (2) years supervisory experience required.
Skills & Knowledge:
- Strong knowledge of utilization review practices
- Expert knowledge of the insurance industry and claims processing
- Acquired knowledge of GM claims process, plan design and customer needs
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Leadership/management/motivational skills
- Analytical and interpretive skills
- Strong organizational skills
- Excellent interpersonal skills
- Excellent negotiation skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT:
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental:� Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical:� Computer keyboarding, travel as required
Auditory/Visual:� Hearing, vision and talking
NOTE:� Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.� They are not intended to constitute a comprehensive list of functions, duties, or local variances.� Management retains the discretion to add or to change the duties of the position at any time.
