Utilization Management Supervisor

ProgenyHealth LLC; United States; On-site; USD 90,000 - 115,000; Full time

Benefits offered by this job

Paid Time Off

401K with company match

Short- and Long-Term Disability

Group Life Insurance

Business Casual work environment

Paid Parental Leave

Tuition reimbursement

Medical, dental, vision benefits

Professional development opportunities

Job summary

ProgenyHealth LLC is seeking an Utilization Management Supervisor to oversee the UM nursing staff and daily operations. You will balance workflows, monitor adherence to metrics, and train new hires to maintain high care standards.

Reporting to the Director of Utilization Management, you will drive continuous improvement initiatives and help align clinical operations with the company mission to improve health outcomes for infants in intensive care nurseries.

Qualifications

• RN license required.
• 2+ years in Managed Care, Utilization Review or Case Management.
• Experience in a team lead or supervisory role preferred.
• 3+ years bedside nursing in NICU/PICU/ICU required.
• Willingness to stay late to manage staff and caseloads.
• URAC standards experience preferred.
• Strong problem-solving skills and diplomacy.
• Self-motivated, organized, and able to prioritize tasks.
• Proficient in Microsoft Office (Word, Outlook).
• Accurate spelling and documentation; commitment to customer service.

Responsibilities

• Manage UM nursing staff and day-to-day operations.
• Adjust work queues to balance workflow and maintain metrics.
• Train new hires and provide ongoing clinical guidance.
• Assess UM program for efficiency and outcome improvements.
• Collaborate with Director of Utilization Management.
• Promote a culture of continuous improvement and quality care.

Skills

RN license

UR/Case Management

Team leadership

Clinical ICU/NICU/PICU

MS Office

Tools

Microsoft Office

Job description

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.

Some of the benefits we offer our team are:

• Paid Time Off
• 401K with company match
• Short- and Long-Term Disability
• Group Life Insurance
• Business Casual work environment

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 matchShort- 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.