[Hiring] Inpatient Utilization Management Clinical Supervisor @WellSense Health Plan

Role Description

The Inpatient UM Clinical Supervisor is responsible for the daily supervision and operations of the Inpatient Utilization Management clinical team. Key responsibilities include:

• Assigning work and ensuring compliance with policies and procedures.
• Being the first point of contact for complex issues to ensure cost-effective utilization management of inpatient admissions.
• Collaborating with the UM Clinical Trainer/QA to train newly hired staff and meet ongoing training needs.
• Using available data to prioritize inpatient reviews, including admission reviews, level of care reviews, and continued stay reviews.
• Working closely with other clinical and non-clinical supervisors within UM to support integrated UM processes.

Qualifications

• Education Required: Bachelor’s degree in Nursing or Associate’s degree with relevant work experience.
• Education Preferred: Master’s degree in Nursing, related clinical field, or Health Care Administration; CCM or Managed Care Certification.
• Experience Required:
  • One year of prior supervisory experience.
  • Two or more years in a managed care organization.
  • Three years related RN experience in an acute care facility or health insurance environment.
• Experience Preferred/Desirable:
  • Experience with inpatient utilization management strongly preferred.
  • Experience with CCMS and/or Jiva, or other utilization management system.
  • Experience with InterQual or other nationally recognized medical necessity criteria.
  • Experience with Medicaid/Medicare recipients and community services.

Requirements

• Successful completion of pre-employment background check.
• Active unrestricted state licensure as a Registered Nurse in the Commonwealth of Massachusetts.

Benefits

• Full-time remote work.
• Competitive salaries.
• Excellent benefits.
• Generous total compensation including medical, dental, vision, pharmacy benefits, merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, and career advancement opportunities.

Company Description

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.