Utilization Review Supervisor

Description

Summary:

This position reports to the Vice President of Managed Care. Under administrative direction is responsible for the overall work product of a Utilization Review team comprised of Utilization Review Nurses and Medical Management Coordinators. The nature of the work involves coaching and counseling, monitoring work performance to assure compliance with company standards and Labor Code rules and regulations, conducting performance evaluations, and instituting corrective action when appropriate.

Essential Duties and Responsibilities:

• Responsible for overseeing the day to day operations of the UR team for all offices of InterMed. 
• Responsible for the timely completion of performance reviews for all personnel within the assigned unit (staff evaluation).
• Provides ongoing advice, mentoring, coaching, counseling and performance feedback to assigned staff (training & development).
• Deals quickly and decisively with personnel issues as they arise. Keeps the supervisor informed with regard to the need for or the progress of any corrective action activities.
• Exhibits a knowledgeable and helpful attitude and projects a professional image on behalf of InterMed and Intercare.
• Performs weekly audits of >10% of reviews per UR Nurse for the purpose of validating accuracy and completeness of the utilization review process.
• Responsible for insisting upon a spirit of teamwork and cooperation between the staff and the personnel of other departments for InterMed and Intercare and other clients.
• Requires a comprehensive knowledge of the Utilization Review guidelines in the Labor Code for the State of California and other states as needed.
• Assist with interviewing, hiring, training, appraising performance, rewarding and disciplining employees, and addressing complaints and resolving problems.
• Oversees training of new staff on computer systems and policy & procedures related to Utilization Review.
• Provides training for Intercare claims team at various locations to ensure timely  and accurate work flow. 
• Plans, assigns, and directs the work of Utilization Review.
• Determines appropriate caseloads that allow for timeliness of requests and productivity that meets      expectations.
• Works with Medical Director to ensure compliance with guidelines for Utilization Review.
• Maintains production performance and savings reports for management review and information.
• Notifies supervisor of potential client issues and works to bring resolution.
• Assists with the implementation of  new accounts with input from account management.
• Assists staff in their compliance  with client service instructions.
• Authorizes requests for time off to  ensure coverage necessary to maintain service guidelines.  
• Handles other duties and tasks as deemed  appropriate by the Vice President of Managed Care.
• Serves as InterMed’s compliance officer to ensure compliance with state and URAC regulations
• Participate as an  active member of InterMed’s Quality Management Program Committee including quarterly meetings to discuss program improvements, measurements,  assessments, and compliance. 
• Participate in a quality management program meeting and project for at least 40% of average hours worked. 
• Maintain awareness of potential compromise in a patient’s safety for each review. Refer to proper authority.
• Uses plain language to communicate (written and verbal) with injured workers, claims examiners, and clients.

Competency:

To perform the position successfully an individual should demonstrate the following competencies: 

• Project Management  - Develops project plans; Coordinates projects; Communicates changes and progress; Completes projects on time and budget; Manages team activities. 
• Change Management - Develops workable implementation plans; Communicates changes  effectively; Builds commitment and overcomes resistance; Prepares and supports those affected by change; Monitors transition and evaluates results. 
• Leadership - Exhibits confidence in self and others; Inspires and motivates others to  perform well; Effectively influences actions and opinions of others; Inspires respect and trust; Accepts feedback from others; Provides vision and inspiration to peers and subordinates; Gives appropriate recognition to others; Displays passion and optimism; Mobilizes others to fulfill the vision. 
• Managing People -  Includes staff in planning, decision-making, facilitating and process improvement; Takes responsibility for subordinates' activities; Is available to staff; Provides regular performance feedback; Develops subordinates' skills and encourages growth; Solicits and applies customer feedback (internal and exter