Utilization Management RN Supervisor (Remote)

ProgenyHealth empowers our health plan and employer partners to change the trajectory of maternal and infant health outcomes across America. Informed by more than 20 years of experience and patient data, our end-to-end maternal and infant care management solution helps ensure the best possible outcomes for every expecting mother we touch. Our wholly integrated solution builds a network of support for an uninterrupted continuum of care from prenatal health, through any resultant NICU stay, and all the way to one full year of life. From the very beginning, we unite early health risk assessment data with self-directed digital tools and dedicated Case Managers who work tirelessly to connect at-risk moms-to-be with the resources, care, and support they need for a healthy, full-term delivery. By promoting predictable, equitable, and standardized high quality care journeys, we ensure healthier outcomes—and lower costs— across your entire at-risk population. In so doing, we help overcome systemic barriers to support healthier pregnancies and healthier starts to life for all moms and babies, one family at a time.

Job location: This position may be performed remotely – candidates outside of the Eastern PA area will be considered.

Job Role

The Utilization Management Supervisor will primarily be responsible for managing the Utilization Management nursing staff in the day to day operations of the department. This includes oversight and adjustment of work queues, when needed, to maintain work flow balance; monitoring and implementing adherence to department and company metrics; training of new hires and on-going clinical; and various other responsibilities to support the clinical nursing staff and the company program. The incumbent will also be responsible for assessment of the UM program for opportunities to improve efficiencies and/or improve outcomes.

Reporting to the Director of Utilization Management, the Supervisor will work closely with the management staff and will play a key role in implementing the culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission statement:

To improve the health outcomes of infants in intensive care nurseries through partnership, care
facilitation, continuous quality improvement and a firm commitment to excellence.

Qualifications

• Registered Nurse (RN) with a current, unrestricted license is required.
• Two or more years of experience in a Utilization Review or Case Management role, is required.
• Three or more years’ experience in a supervisory role managing nursing staff is desired
• Three or more years of clinical experience as a bedside nurse in NICU/PICU/Peds is required.
• Must be available to stay late as needed to manage staff and caseloads.
• Experience with URAC & NCQA standards preferred.
• Must have demonstrated strong problem-solving skills.
• Must have proven track record of utilizing tact, diplomacy and strategic thinking in addressing issues and changes in company policy, etc.
• Must be self-motivated and willing to learn multiple tasks.
• Must be well organized and able to prioritize tasks.
• Must have good computer skills and be familiar with using Microsoft Office (Word, Outlook etc).
• Must demonstrate accuracy in spelling and documentation.
• Must have commitment to excellence in customer service.

Benefits/Culture

Our team is our most important asset. some of the benefits we offer our team are:

• 401K with company match
• Medical and dental benefits
• Paid Parental Leave
• Long Term Disability
• Paid Time Off
• Team orientated events throughout the year