Supervisor, Acute & Post-Acute Utilization Management

Medical Mutual; Cleveland (OH); Híbrido; USD 85.000 - 110.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Laptop provided

On-site fitness center

On-site cafeteria

Employee discounts

Cash rewards program

Business casual attire

Descripción de la vacante

Medical Mutual in Brooklyn, OH is seeking a Nursing Supervisor to oversee utilization staff, ensuring medical necessity guidelines are applied for inpatient, concurrent, and retrospective reviews. You will collaborate with physician reviewers to support safe discharges and timely care transitions.

The role requires an Ohio RN license, with BSN preferred, and 7+ years in utilization review with leadership experience. Hybrid onsite three days per week in Brooklyn, OH.

Formación

• RN license in good standing with Ohio; Bachelor's degree preferred.
• 7+ years of progressive RN experience in utilization review or case management.
• Experience leading teams or projects within health insurance/utilization management.

Responsabilidades

• Oversee daily operations of utilization staff and drive performance and engagement.
• Facilitate collaboration across disciplines for utilization management and discharge planning.
• Ensure data collection for authorizations and monitor performance and timeliness.
• Maintain compliance with policy, procedures, and regulatory standards.
• Support onboarding, training, and professional development of staff.

Conocimientos

Leadership

Change management

Data analysis

Discharge planning

Educación

RN licensure (OH)

BSN preferred

Healthcare Administration knowledge

Herramientas

Microsoft Office

ICD-10/CPT/HCPCS

Healthcare systems knowledge

Claims management systems

Descripción del empleo

Medical Mutual employees must submit their applications through MySource.

Note: This is a hybrid position located in Brooklyn, OH, with a three-day per week onsite requirement.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Job Summary:

Supervises assigned utilization staff. Ensures utilization staff appropriately apply medical necessity guidelines in making authorization determinations for inpatient admissions, concurrent, and retrospective reviews in collaboration with physician reviewers. Oversees processes to support evidence-based discharge planning so that patients have a safe and timely transition to next level of care.

Responsibilities:

• Supervises daily operations of assigned utilization staff. Provides leadership and change management to improve retention, efficiency, and quality outcomes. Fosters a transparent, high-performance culture through clear goals, performance feedback, and effective communication.
• Facilitates interdisciplinary collaboration for utilization management and discharge planning.
• Supports onboarding, training, coaching, and professional development. Applies evidence-based criteria and standards to support quality utilization management and discharge planning.
• Ensures that utilization staff appropriately gather the requisite data and information to enter authorizations. Tracks, trends and monitors the accuracy of data and timeliness of authorization decisions. Monitors designated reports to ensure internal controls are effective. Drives towards solutions that support departmental goals.
• Evaluates individual and team performance against established targets; motivates staff to meet departmental and organizational goals related to utilization, cost, quality and productivity targets; accountable for the team's overall results as well as driving employee engagement as measured by employment surveys.
• Assists Manager in coordinating and facilitating system processes with providers, partners, vendors, and subcontractors as necessary.
• Ensures compliance with company policy and procedure, as well as state and federal rules and regulations and accreditation standards.
• Performs other duties as assigned.

Qualifications:

Education and Experience:

• Graduate of a registered nursing program approved by the Ohio State Nursing Board. Bachelor of Science in Nursing or Healthcare Administration preferred.
• 7 years or more progressive experience as a Registered Nurse (RN) in health insurance utilization review or case management, or equivalent relevant RN experience in a clinical practice.
• Relevant experience leading teams or projects.

Professional Certification(s):

• Registered Nurse with current Ohio unrestricted license required.
• Lean Six Sigma Yellow Belt preferred.

Technical Skills and Knowledge:

• Intermediate proficiency in Microsoft Office and web-based applications.
• Knowledge of healthcare delivery systems, managed care operations, health insurance benefits, and network design.
• Knowledge of medical terminology, coding, and claims management, including ICD-10, CPT, and HCPCS.
• Knowledge of HIPAA and applicable regulatory requirements.
• Knowledge of patient care continuums, expected outcomes, and community-based resources.
• Ability to analyze data, identify root causes, and apply continuous process improvement methodologies.
• Knowledge of Lean Six Sigma principles preferred.
• Ability to manage multiple priorities, solve complex problems, and adapt in a fast-paced environment.
• Ability to lead teams and facilitate change.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.