JOB SUMMARY

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The Supervisor Utilization Review RN is accountable for daily oversight of the Utilization Review (UR) function, and provides direction for complex cases, monitors pending cases, reviews and gives feedback to trainers regarding staff education opportunities, and acts as a liaison with interdepartmental communication.

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ESSENTIAL FUNCTIONS OF THE ROLE

\n\nFunctions as a working Supervisor for Utilization Review Department, through the monitoring of staff workload, creating assignments, reviewing productivity, conducting quality reviews, advising with peer-to-peer appeals, and advising with denial research.\nCompiles data for productivity reports on a weekly basis to help staffing outcomes and quality metrics.\nPartner with Care Coordination Medical Director on patients not meeting criteria and informs Clinical Resource Manager/Director as needed.\nCompletes daily staff assignments to ensure adequate service levels\nMonitors daily observation report and identify any potential issues\nResolves escalations received from UR Nurses and staff\nConducts quality reviews as assigned\nResponds to UR questions from staff and stakeholders\nServes as a Subject Matter Expert' (SME) for UR workflow issues, complex cases, denials and internal/external customers\n\n

KEY SUCCESS FACTORS

\n\nAbility to assist people in recognizing and solving problems.\nAbility to supervise, motivate, and provide guidance to staff to ensure their clinical proficiency.\nExcellent written and verbal communication skills.\nAbility to work effectively with employees at all levels within the organization, including physician and executive leadership.\nKnowledge of discharge planning, case management and utilization review.\nAbility to make tactical steps around the allocation and direction of the work of supervised employees using established guidelines, policies and/or procedures.\nAbility to make effective hiring and termination recommendations.\nAbility to train, and evaluate performance of supervised staff.\nGeneral computer skills, including but not limited to: Microsoft Office, information security, scheduling and payroll systems, electronic medical documentation, and email.\n\n

BENEFITS

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Our competitive benefits package includes the following

\n\nImmediate eligibility for health and welfare benefits\n401(k) savings plan with dollar-for-dollar match up to 5%\nTuition Reimbursement\nPTO accrual beginning Day 1\n\n

Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

- EDUCATION - Associate's

- MAJOR - Nursing

- EXPERIENCE - 4 Years of Experience