Supervisor, Utilization Manager

North Mississippi Medical Center, Inc; United States; On-site; USD 83,000 - 104,000; Full time

Job summary

North Mississippi Health Services seeks a Supervisor of Utilization Management to oversee Women's Hospital Case Management and ensure quality service and outcomes. This role guides staff, assigns patients, coordinates education, recruitment, and treatment to maintain high standards.

The position supervises daily activities, reviews claims, applies interqual criteria, and collaborates with payers and physicians while supporting budgeting and regulatory compliance.

Qualifications

• Excellent organizational and communication skills are required.
• Knowledge of payer sources, laws and cost containment is required.
• Demonstrates ability to care for a broad patient population.

Responsibilities

• Supervises daily activities of Women's Hospital Case Management.
• Reviews claims and applies Interqual criteria for level of care.
• Coordinates staff education and orientation within the department.
• Partners with managers to recruit and plan staffing.
• Ensures compliance with NMHS/NMMC policies and regulatory standards.
• Reports on budget and operational performance daily.

Skills

Organizational skills

Communication skills

Payer knowledge

Interpersonal skills

Regulatory knowledge

Education

Bachelor's Degree in Nursing

Master's Degree in Nursing (not required)

Job description

We believe a career is more than just a career - it's a calling. Our teammates' \"True North\" is what calls them to health care; it's their passion. At North Mississippi Health Services, we believe in helping you leverage and connect that passion with a much greater purpose that impacts people you know and love.

Department: 10007915 Utilization Management

Work Shift: Primarily Mon thru Friday with some weekend required. Variable shift.

Job Description:

The Supervisor of Utilization Management at North Mississippi Health Services is responsible for overseeing Women's Hospital Case Management and ensuring staff meets expectations for quality service and functional outcomes. They must also make decisions related to staffing, patient assignments, continuing education, recruitment, and patient treatment to maintain a high standard of care within the department. As a supervisor, this role oversees and guides a team of employees to ensure efficient task completion, promoting teamwork and effective coordination.

JOB FUNCTIONS

Supervision:

• Supervises and oversees the daily activities of Women's Hospital Case Management.
• Evaluates and provides feedback regarding individual and team performance (EXCEL).
• Recommends corrective/disciplinary actions for staff within scope of responsibility.
• Ensures that staff is meeting expectations such as placing a patient in the appropriate status at admission, applying interqual criteria, etc.
• Ensures that staff is providing quality service and functional outcomes.

Utilization Management:

• Reviews claim denials and appeals.
• Identifies the need for new resources if gap exist in service continuum and initiatives creative care delivery option.

Communication:

• Meets daily with Utilization Review team as necessary to address any pertinent outliers.
• Attends all required departmental, facility, and payer meetings.

Reporting:

• Conducts daily review of claims, applies appropriate interqual criteria for the appropriate level of care, coordinates and completes physician/payer communication.

Educations:

• Coordinates and provides orientation to all new personnel within Department.
• Educates physicians and other care team member on level of care criteria and other third party payer requirements.
• Ensures staff maintains current licensures/annual review/competencies.

Budget:

• Assists with departmental budget development and compliance.

Recruitment:

• Partners with Managers and Employment Services to develop and implement recruitment plan/strategies.

Regulation:

• Adheres to NMHS/NMMC Policies/Procedures/Guidelines.
• Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues.
• Refers all potential quality care issues to the Case Management Director daily to facilitate timely follow-up.

Knowledge Skills and Abilities

• Excellent organizational and communication (written and verbal) skills; required
• Knowledge of various payer sources, federal/state laws/regulations, and cost containment; required
• Excellent interpersonal skills; required
• Demonstrates ability to care for a patient population from pediatric to geriatric; required
• Develops and implements departmental policies and procedures
• Coordinates, supervises, and evaluates clinical issues of Utilization Review and support personnel
• Leads staff meetings as appropriate
• Conducts employee disciplinary process and implements action plans when indicated
• Coordinates daily assignments appropriately
• Implies new strategies as mandated by NMHS to adhere to all regulatory standards
• Must negotiate equitable solutions in the area of continuing education, time off, and coverage to assist staff intervention
• Must have frequent contact with: payers and physicians
• Must have excellent written and verbal communication skills
• Must reflect a positive, caring attitude toward clients, patients, staff and the public we serve

Physical Demands

• Standing. Constantly
• Walking. Constantly
• Sitting. Occasionally
• Lifting/Carrying. Frequently 50 lbs
• Pushing/Pulling. Frequently
• Climbing. Occasionally
• Balancing. Occasionally
• Stooping/Kneeling/Bending. Occasionally
• Reaching/Over Head Work. Occasionally
• Grasping. Frequently
• Speaking. Constantly
• Hearing. Constantly
• Repetitive Motions. Constantly
• Eye/Hand/Foot Coordinations. Frequently

Salary Range:

$83,179.20-$103,979.20

Education:

Bachelor's Degree | Nursing | Required

Master's Degree | Nursing | Not Required

Certifications:

Registered Nurse (MS) - MS Board of Nursing