UM Clinical Supervisor

US-Remote - Irvine, CA or Detroit, MI
Req No.
2017-2203
Category
Clinical/Medical
Type
Regular Full-Time

Overview

ConcertoHealth delivers comprehensive care to Medicare, Medicaid, and complex-needs patients. For over a decade, we have provided extraordinary outcomes for thousands of people in these underserved groups.
The ConcertoHealth name reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. It’s about the harmony of a patient’s care, health, and dignity.
 
Summary:
The UM Clinical Supervisor is responsible for providing oversight to the UM nurses who process requests for both inpatient and outpatient reviews. The UM Clinical Supervisor will work collaboratively with their team as well as with providers to promote quality, cost and effective medical care by applying clinical acumen and the appropriate application of policies and guidelines to authorization requests. The UM Clinical Supervisor serves as an active advocate for the members’ rights and plays a key role as a resource to the Medical Director and Manager of UM.

Responsibilities

  • Provide leadership and oversight to the members of the UM clinical team by being a resource and subject matter expert for the nurses performing utilization management tasks.
  • Work collaboratively with the Medical Director and Manager of UM and the IT department to identify and analyze metrics related to utilization management and clinical care.
  • Provide feedback and guidance to the UM clinical team to optimize the quality of their work product.
  • Assist the UM clinical team and take a lead role in the authorization review process as needed.
  • Provide supervision to implement and coordinate all utilization management clinical functions.
  • Identify barriers and facilitate problem resolution and follow-up.
  • Provide support and oversight to UM clinical team ensuring the member is in the right place, getting the right care, at the right time.
  • Assists UM clinical team to ensure that they initiate and continue direct communication with health care providers involved with the care of the member to obtain complete and accurate information.

Qualifications

  • Licensed Nurse
  • 3-5 years of experience in a healthcare, patient oriented customer service position required
  • Experience with the populations who are beneficiaries of government programs, including community-based and facility-based people with medical and/or behavioral needs
  • Utilization Management experience required
  • Care Management experience preferred

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