Utilization Management Supervisor

ProgenyHealth, LLC; Harmonville (PA); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Paid Time Off

Paid Parental Leave

Medical, dental, vision benefits

401K with company match

Short- and Long-Term Disability

Group Life Insurance

Tuition reimbursement

Professional development opportunities

Business Casual work environment

Job summary

ProgenyHealth, LLC is seeking an Utilization Management Supervisor in Harmonville, PA to oversee day-to-day UM nursing operations and ensure adherence to metrics. You will train staff, balance workloads, and drive efficiency while supporting the company mission to improve infant health outcomes.

The role requires RN licensure and 2+ years in managed care or utilization review, plus strong leadership, problem-solving, and organizational skills. collegial collaboration with leadership is expected.

Qualifications

• RN license required
• Minimum 2+ years in Managed Care, Utilization Review, or Case Management
• Experience in a team lead or supervisory role preferred
• 3+ years of bedside nursing experience in NICU/PICU/ICU required
• Ability to stay late to manage staff/caseloads
• Strong problem-solving skills
• Diplomacy and strategic thinking in policy changes
• Self-motivation and willingness to learn multiple tasks
• Excellent organization and task prioritization
• Proficient computer skills; accurate spelling and documentation

Responsibilities

• Manage UM nursing staff and day-to-day operations
• Oversee and adjust work queues to balance workload
• Train new hires and ongoing clinical staff
• Monitor adherence to department and company metrics
• Assess UM program for efficiency improvements and outcomes
• Report to the Director of Utilization Management and collaborate with leadership
• Support culture and environment promoting continuous improvement

Education

RN license

Tools

Microsoft Office

Outlook

Job description

Job Role

The Utilization Management Supervisor will primarily be responsible for managing the UM nursing staff in the day to day operations of the department. This includes oversight and adjustment of work queues, when needed, to maintain work flow balance; monitoring and implementing adherence to department and company metrics; training of new hires and on-going clinical; and various other responsibilities to support the clinical nursing staff and the company program. The incumbent will also be responsible for assessment of the UM program for opportunities to improve efficiencies and/or improve outcomes.

Description

Job Role

The Utilization Management Supervisor will primarily be responsible for managing the UM nursing staff in the day to day operations of the department. This includes oversight and adjustment of work queues, when needed, to maintain work flow balance; monitoring and implementing adherence to department and company metrics; training of new hires and on-going clinical; and various other responsibilities to support the clinical nursing staff and the company program. The incumbent will also be responsible for assessment of the UM program for opportunities to improve efficiencies and/or improve outcomes. Reporting to the Director of Utilization Management, the Supervisor will work closely with the management staff and will play a key role in implementing the culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission statement: To improve the health outcomes of infants in intensive care nurseries through partnership, care facilitation, continuous quality improvement and a firm commitment to excellence.

Requirements

Qualifications

• Registered Nurse (RN) with a current, unrestricted license is required.
• Two or more years of experience in Managed Care, in a Utilization Review or Case Management role, is required.
• Experience in a team lead or supervisory role managing nursing staff is desired.
• Three or more years of clinical experience as a bedside nurse in NICU/PICU/Peds/ICU required.
• Must be available to stay late as needed to manage staff and caseloads.
• Experience with URAC standards preferred.
• Must have demonstrated strong problem-solving skills.
• Must have proven track record of utilizing tact, diplomacy and strategic thinking in addressing issues and changes in company policy, etc.
• Must be self-motivated and willing to learn multiple tasks.
• Must be well organized and able to prioritize tasks.
• Must have good computer skills and be familiar with using Microsoft Office (Word, Outlook etc)
• Must demonstrate accuracy in spelling and documentation.
• Must have commitment to excellence in customer service.

Benefits

Some of the benefits we offer our team are:

• Paid Time Off
• Paid Parental Leave
• Medical, dental, vision benefits
• 401K with company match
• Short- and Long-Term Disability
• Group Life Insurance
• Tuition reimbursement
• Professional development opportunities
• Business Casual work environment

ProgenyHealth positively recruits people from diverse backgrounds, including individuals with disabilities - if you need an accommodation to interview, please contact us by email: [e-mail]

All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status.