- Assist with the daily operations of licensed staff on the UR team.
- Monitor staff work assignments and make appropriate adjustments based on staffing levels, staff experience, and number/request types of authorizations/appeals received.
- Provide coaching and counseling to improve productivity of staff members within UR.
- Hire, develop, mentor, and build a performance-driven UR team. Write and deliver annual reviews for direct reports with UR Manager input.
- Plan, develop and support (or conduct) orientation, training programs, and prepare educational material for staff members to improve skills, aid in professional growth and development, and to ensure staff expertise.
- Review quality audits and share audit results in a timely manner with UR Specialists, providing necessary education and counseling to improve performance.
- Collaborate with UR Manager and leadership to develop and implement performance measures and monitor and provide feedback to UR Specialists on performance measures.
- Serve as the hierarchy for Utilization Management (UM) staff on the review of denial notification letters to confirm determination rational reflects and conforms to regulatory compliance, requirements, and timelines.
- Develop and maintain a comprehensive knowledge of UCare product and member benefits.
- Understand and follow UCare criteria hierarchy for UM. Understand and follow UCare policies and procedures.
- Participate in process reviews and the development of new and/or revised work processes, policies, and procedures relating to UR.
- Stay current on health plan products, member benefits, navigating claims systems, and regulatory requirements to accurately answer questions from members, providers, and internal customers. Stay current with UCare's policies and procedures.
- Act as a liaison with outside entities regarding prior authorization requests, including but not limited to: physicians, hospitals, DME vendors, SNF, social service agencies, member advocates, regulatory agencies.
- Create and support an environment that fosters teamwork, cooperation, respect, and diversity.
- Establish and maintain positive communication and professional demeanor with internal and external customers, providers, and members.
- Other projects and duties as assigned
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Utilization Review Supervisor - Minneapolis, United States - UCare Minnesota
Description
ABOUT UCARE
UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.
WORKING AT UCARE
Working at UCare is more than a career; it's a mission.
A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other.
Employees join UCare and stay because of the opportunity to have a purpose-driven job.
Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 14 consecutive years since the awards program began.
Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.
Position Description
As the Utilization Review (UR) Supervisor, you will be responsible for providing daily oversight of UR Specialists within Clinical Services.
Responsibilities include providing clinical, technical, and operational support and direction, setting priorities for the team to ensure that assigned job duties are completed.
Assist with updates to the utilization management model based on process improvement strategies, organizational goals, and data. Responsible for direct supervisory oversight of UR professionals reviewing requests for authorizations.Monitor authorization activities, inter-rater reliability (IRR), shaping member care and other quality measures to ensure departmental, contractual, and regulatory requirements are met.
Mentor, coach, develop and evaluate individual staff performance.
Utilization Review Supervisor professionals in Minneapolis
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Ninad Khade
Manufacturing Engineer
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Jesse Miller
Hard Worker
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Kelly Beaupre
Client relationship manager
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Kelly Brabec
Clinical Documentation Integrity Advisor, RN