Remote RN UM Supervisor - Utilization and Care Coordination

Dignity Health; Rancho Cordova (CA); Hybrid; USD 112,000 - 165,000; Full time

Benefits offered by this job

Home office equipment provided

Job summary

Dignity Health Medical Foundation in California seeks a Supervisor of Utilization Management to lead the Pre-Authorization team, ensure timely reviews, and maintain regulatory compliance. The role supports a remote work setup with occasional onsite meetings within driving distance of Sacramento.

You will supervise staffing, coach staff, and partner with Medical Directors to optimize patient care and program cost savings. A CA RN license and strong UM knowledge are required.

Qualifications

• Five (5) years clinical experience.
• Three (3) years Utilization experience in health plan/UM operations, acute or subacute utilization review.
• Bachelor's degree, or equivalent experience
• Clear and current CA Registered Nurse (RN) license
• Ability to demonstrate leadership and management skills
• Knowledge of all applicable federal and state regulations as well as accreditation standards
• Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory requirements
• Must have the ability to monitor, compile, report and analyze data/statistics
• Requires excellent human relations, interpersonal and oral/written communication skills
• Able to recognize and address the needs and concerns of customers
• Ability to interact with all levels of the organization as well as with external contacts
• Requires good knowledge and skills with Microsoft Office (ie: Word and Excel) and other computer information systems and applications

Responsibilities

• Responsible for day to day operations of the Pre-Authorization team to include timely response and appropriate evaluation of referral reviews, correct selection of criteria, accurate prep to the UM Physician reviewer when indicated, timely verbal and written documentation, and completion of the file.
• Ensures adequate staffing and assignments and adjusts workflow as needed to meet department goals. Manages team schedule including requests for time off and assurance of coverage during physician office hours.
• Organizes, structures, and chairs a minimum of one pre-authorization meeting per month, including other staff as appropriate.
• Motivates and coaches staff to include new-hire training, problem solving, and special projects. Assists manager with performance activities to include monitoring, coaching, educating, and providing feedback to team.
• Ensures UM Physicians are provided the relevant information needed to accurately review a referral. Fosters the relationship between the Pre- Authorization team and the Medical Director and Physician Reviewers.
• Tracks cost savings from activities over time to evaluate success of programs. Maintains or removes programs based on organization and department goals. Develops reports for leadership as required

Skills

Leadership

Communication

Regulatory knowledge

MS Office

Data analysis

Education

Bachelor's degree or equivalent

Tools

InterQual

Job description

Dignity Health Medical Foundation in California seeks a Supervisor of Utilization Management to lead the Pre-Authorization team, ensure timely reviews, and maintain regulatory compliance. The role supports a remote work setup with occasional onsite meetings within driving distance of Sacramento.

You will supervise staffing, coach staff, and partner with Medical Directors to optimize patient care and program cost savings. A CA RN license and strong UM knowledge are required.