[Hiring] RN Supervisor UM Prior Auth @CommonSpirit Health

Role Description

As our Supervisor of Utilization Management (UM), under the guidance and supervision of the department Manager/Director, you will be responsible and accountable for coordination of services for Mercy Medical Group and Woodland Clinic Medical Group through an interdisciplinary process that provides a clinical and financial approach through the continuum of care.

• Promote the quality and cost effectiveness of medical care by ensuring department staff apply clinical acumen and appropriate policies to Managed Care prior authorization referral requests.
• Coordinate daily operations of the UM Pre-Authorization team to ensure requests are processed consistently and timely while observing regulatory guidelines.
• Work remotely with provided equipment, including a laptop, docking station, dual monitors, and accessories.
• Primarily work-from-home within driving distance of Sacramento, CA, with occasional onsite meetings.
• Work rotating weekends.
• Responsible for day-to-day operations of the Pre-Authorization team, including:
• Timely response and appropriate evaluation of referral reviews.
• Correct selection of criteria and accurate preparation for UM Physician reviewer.
• Timely verbal and written documentation, and completion of the file.
• Ensure adequate staffing and assignments, adjusting workflow to meet department goals.
• Manage team schedule, including requests for time off and assurance of coverage during physician office hours.
• Organize, structure, and chair a minimum of one pre-authorization meeting per month.
• Motivate and coach staff, including new-hire training, problem solving, and special projects.
• Assist manager with performance activities, including monitoring, coaching, educating, and providing feedback to the team.
• Ensure UM Physicians receive relevant information for accurate referral review.
• Foster relationships between the Pre-Authorization team and the Medical Director and Physician Reviewers.
• Track cost savings from activities to evaluate program success and develop reports for leadership as required.

Qualifications

• Five (5) years clinical experience.
• Three (3) years Utilization experience in health plan/UM operations, acute or subacute utilization review.
• Bachelor's degree, or equivalent experience.
• Clear and current CA Registered Nurse (RN) license.
• Ability to demonstrate leadership and management skills.
• Knowledge of all applicable federal and state regulations as well as accreditation standards.
• Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory requirements.
• Ability to monitor, compile, report, and analyze data/statistics.
• Excellent human relations, interpersonal, and oral/written communication skills.
• Able to recognize and address the needs and concerns of customers.
• Ability to interact with all levels of the organization as well as with external contacts.
• Good knowledge and skills with Microsoft Office (i.e., Word and Excel) and other computer information systems and applications.

Requirements

• Seven (7) years UM experience with Charge/Lead/Supervisory/Management experience in Utilization Management department preferred.
• Previous prior authorization experience strongly preferred.
• Managed care experience preferred.
• Experience working with health plan auditors preferred.
• Working knowledge of InterQual preferred.
• Knowledgeable of NCQA and ICE preferred.

Company Description

Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. It is an affiliate of Dignity Health – one of the largest health systems in the nation.

• Works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services.
• Continues to grow and establish new premier care centers, providing support and investment in the latest technologies and state-of-the-art medical facilities.
• Delivers high-quality, patient-centric care with an emphasis on humankindness.
• Strives to create purposeful work settings where staff can provide great care while advancing in knowledge and experience.
• Maintains a well-trained and highly skilled staff, vital to maintaining excellence in care and service.