Supervisor - RN, Utilization Management
SSM Health
It's more than a career, it's a calling.
MO-REMOTEWorker Type:
RegularJob Summary:
Responsible for the oversight and management of daily operations within assigned region(s) or ministries related to the Utilization Management (UM) Review area under the direction of managers. Interacts directly with UM staff, Case Management staff, and providers. Exercises discretion and independent judgment that directly supports UM activities.Job Responsibilities and Requirements:
PRIMARY RESPONSIBILITIES
Responsible for daily Utilization Management (UM) operations, which includes referrals, medical necessity and experimental/investigational reviews, application of medical policies, and business processes. Reviews electronic medical record and screens clinical information with nationally recognized criteria.Ensures the quality and accuracy of UM review decisions and adherence to policy.Adjusts staffing patterns to provide adequate coverage for UM operations during absences and vacancies.Assists with the development and maintenance of UM programs and adherence to regulatory and accreditation requirements.Ensures team meets performance metrics including accuracy and productivity based on departmental guidelines.Actively engages team members in participating with the team regarding opportunities for improvement in standard work.Reviews and evaluates staff participation, individually and as a team member, on projects to identify problems and improve work processes and systems.Promotes timely and effective communication based on individual and/or situational requirements and utilizes appropriate means to ensure adequate information flow.Acts as a leader and a resource to staff. Works collaboratively and supports the efforts of team members.Provides input for hiring, training, leading and evaluating staff.Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department's scope of service.As an SSM Health nurse, I will demonstrate the professional nursing standards defined in the professional practice model. Uses the ANA Code of Ethics for Nurses to guide his/her response to the current and evolving health and nursing needs of our patients and our patient populations.Performs other duties as assigned.
EDUCATION
EXPERIENCE
PHYSICAL REQUIREMENTS
REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS
State of Work Location: Illinois
State of Work Location: Missouri
State of Work Location: Oklahoma
State of Work Location: Wisconsin
Work Shift:
Day Shift (United States of America)Job Type:
EmployeeDepartment:
8746030033 Sys Utilization ManagementScheduled Weekly Hours:
40SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.
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