Supervisor, Utilization Management (Active RN)

Comagine Health is looking for a Supervisor, Clinical Review to join our team in Care Management! In this role you will engage in personnel management activities, including but not limited to recruitment, selection, on-boarding, training, evaluation, and separation. The ideal candidate will me in the Pacific or Mountain Time Zones.

Who is Comagine Health?

Comagine Health is a national, nonprofit, health care consulting firm. We work collaboratively with patients, providers, payers, and other stakeholders to reimagine, redesign and implement sustainable improvements in the health care system.

As a trusted, neutral party, we work in our communities to address key, complex health, and health care delivery problems. In all our engagements and initiatives, we draw upon our expertise in quality improvement, care management, health information technology, analytics, and research.

We invite our partners and communities to work with us to improve health and redesign the health care delivery system.

Some of what you'll do:

Leadership Competencies:

• Conducts a variety of personnel management activities, including but not limited to recruitment, selection, on-boarding, training, evaluation, and separation, according to Comagine Health policy and practice and in collaboration with leadership and Human Resources.
• Delivers, or ensures delivery, of initial orientation and training (including review of direct reports' job descriptions), plus on-going training.
• Ensures availability of procedures, technology, and other resources necessary to conduct work activities; provides subject matter expertise as applicable.
• Provides timely, continuous recognition and feedback using objective, job-related data, and observations (including documented performance appraisals); timely initiates performance improvement opportunities in alignment with Comagine Health policy and practice.
• Develops and monitors professional development goals and objectives; assigns work and delegates authority appropriate for established, job-related duties, responsibilities, and qualifications.
• Develops, maintains, and enforces individual- and team-level performance expectations for deliverables; applies Comagine Health's general standards of conduct.

Ensures the integrity and high quality of utilization management services

• Assist with developing and updating Organizational/ contractual policies and review process
• Ensure that Clinical staff meets all required legal, contractual, and accreditation standards and compliance with corporate policies
• Accepts utilization management assignments when work volumes or case complexities require supervisory intervention and support
• Provide subject matter expertise on contractual provisions and relevant regulations in conjunction with the manager
• Coordinate the team's workflow and operations to ensure timeliness and deliverables
• Conducts informal audits quarterly and ad hoc to ensure adherence to criteria.
• Perform 1:1 training, group training based on staff performance to measure progress and training effectiveness.
• Assists with report preparation and internal quality control review
• Administer new hire onboarding activities and training.
• Refer cases to other professionals internally, including behavioral health team and medical consultation, and other appropriate external sources, when indicated.
• Participate in candidate interviews.
• Assist with fair hearing process.
• Promote, monitor, and improve positive customer service behaviors, communications, and attitudes by all staff in the provision of services to all stakeholders
• Ensures that Manager or designee is informed in a timely manner regarding significant operational issues, performance measures, complaints/grievances, compliments, quality management initiatives, staffing concerns, and other relevant topics
• Collaborate with Medical Affairs for complex case review and clinical topics
• Other duties as assigned

Required Qualifications:

• Current, active, unrestricted registered nurse licensure.
• If incumbent performs case management work, must either possess case management certification (CCM) or be so certified within two years from date in position.
• 3 years of medical management experience
• 3 years of customer service or other relevant work experience

Desired Qualifications:

• 5 years of clinical (direct patient care) experience preferred
• 1 year of supervisory or lead experience Preferred

Specialized Knowledge, Skills, and Abilities and/or Competencies

• The supervisor, will display, critical thinking abilities, strong leadership skills, wise decision-making abilities, organized, knowledgeable and excellent communicator.
• Strong knowledge of Medicaid, process and policies as well understanding of quality control management.
• InterQual criteria experience preferred

Salary Range: $81,000 - $113,000

The salary range posted reflects the range that Comagine is willing to pay for this position. Salary is determined by many factors, including but not limited to geographic location of where the employee will perform their job duties in addition to their knowledge, skills, education, and relevant work experience.