Our client is a nonprofit total health solutions company dedicated to transforming the way people experience the health care system. They’ve been providing healthcare solutions for over 90 years. Their portfolio of companies spans health care information technology and software development; retail health care; health insurance plans; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access; and free-standing health and wellness solutions. Do enjoy getting to the bottom of things? Asking the right questions can make a world of difference in their members’ health. Your knowledge and guidance can mean better outcomes and peace of mind. Put your interests and knowledge to work as a Supervisor of Utilization Review in one of four locations: Portland, OR; Seattle, WA; Tacoma, WA; Lewiston, ID.
Supervisor of Utilization Review Responsibilities:
- Assist in the design and day-to-day operational oversight of pre-service review, admission review, concurrent review and discharge planning processes
- Supervise staff and oversee and coordinate the activities of the utilization management professional staff
- Participate in the departmental strategic plan development and promote achievement of department goals consistent with corporate objectives
- Assure that medically necessary, cost-effective quality care is delivered according to program specifications
- Coordinate activities with external vendors and other organizations that provide inpatient review services
- Participate in strategic initiatives to expand or focus review activities in other areas of care
Supervisor of Utilization Review Requirements:
- The Supervisor of Utilization Review will have strong operations work management skills such as experience with call centers, inpatient review units, process improvement, phone service management and reviewer audits.
- Must have 3 years of experience in one of the service areas (utilization management, case management, condition management, medical operations or behavioral health management) in a health insurance company
- 2 years previous supervisory experience required
- Lead and manage teams including setting and managing to performance standards; manage teams in multiple locations
- Work with claims data to identify opportunities
- Knowledge of health insurance industry trends and new technology
- Current RN, PA, or NP License or Professional Certification in a relevant clinical specialty; and 3+ years clinical practice experience
- A Bachelor’s (or higher) degree in a health-related field preferred
Please contact Scott
Thompson for immediate confidential consideration and additional details.
Phone: 515-216-5455
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