UM Supervisor - Inpatient Services
Company: Optum
Location: Tacoma
Posted on: January 13, 2021
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Job Description:
UM Supervisor - Inpatient ServicesIn support of NPN's mission,
vision, and strategic goals, the Inpatient Services Supervisor is
responsible for building, developing, and maintaining high
performing, effective, efficient teams within a framework that
supports operational policy, procedure, and organizational goals.
Supports the collections and management of all associated data,
reports, auditing requirements, policies, procedures, and database
management. The Supervisor mentors and supports training of staff
that are direct reports.ESSENTIAL DUTIES & RESPONSIBILITIES*
Oversees utilization and concurrent reviews of all inpatient stays
using InterQual/Milliman criteria, assures appropriate approval of
inpatient bed days, identifies and evaluates delays in care,
assists with facilitation of discharge planning and transitions to
alternative care settings when medically appropriate.* Ensures
teammates are working with relevant medical entities to assure
members are transitioned to appropriate levels of care and all
supporting resources are available either through the healthcare
benefits or other supporting entity.* Responds to questions from
hospitals and members about the necessary steps of the inpatient
hospital referral authorization process.* Monitors and follows
relevant time frame standards for conducting and communicating
utilization review determinations.* Supports identification of
appropriate care management referrals through triage process during
care transition to case management staff.* Works closely with the
CMO and Manager to obtain timely medical decisions on pended
hospital authorizations.* Ensures notification to appropriate
leadership of any costly inpatient stays that may reach stop-loss
threshold.* Ensures submission of TPL notifications of any
potential Workers Compensation or Third-Party Liability cases that
OCN may not be financially responsible for to the appropriate
departments* Works with the department Manager to develop, monitor
and maintain the daily operations in alignment with OCN strategic
goals and objectives.* Assists in development of short-term and
long-term (annual) department goals in alignment with
organizational strategic goals and objectives.* Supports the
department leadership in preparation semi-annual and annual health
plan Audits in compliance with state, health plan, and national
regulatory and quality standards.* Keeps current on health plan
benefits, compliance, and other regulatory changes to support
training and operational needs. and structure and researches
unusual requests with health plan* Maintains statistical tracking
and monitoring of operational metrics for the assigned functions.*
Routinely produces communication as needed to satisfy education al
requirements for changes in policies and procedures* Acts a
resource and responds to questions from medical offices, hospitals,
and members when questions relate to department functions* Creates
accurate tools/workflow/process documents for departmental
operational services.* Assists in the development and
implementation of job specific policy and procedures* Assists with
the Research for new training materials and resources that might
enhance training procedures and provide value to employees*
On-boards new teammates and coordinates training* Provides
oversight and determines additional training points during the
onboarding period and communicates to the training team and/or
manager* Identifies gaps in training material or content that
should be filled to ensure process accuracy and productivity*
Communicates with teammates, trainer, and leadership to ensure all
training needs are met for onboarding and ongoing development*
Audits documentation and processes in a regular basis and giving
feedback to the leads and managers* Assures training completion for
all new implemented plan delegation/compliance requirements such as
letters and reporting and any system changes* Manages staffing,
leave, absences, and timecards for all direct reports* Conducts
performance development ratings for all direct reports provides
coaching with oversite from Manager* Assures direct reports meet
performance expectations and administer individual job performance
counseling as needed.* Assists with the development of programs to
systematically identify high-risk members and high volume/high cost
services; and track and improve utilization over time as it relates
to your department responsibilities* Assists with the development
of individual member and population-based strategies to address
care gaps and/or utilization variances as it relates to your
department responsibilities* Works as a team member with
physicians, administration, staff, and other managers within the
department and organization* Educates members, track compliance
with medical treatment and intervene appropriately.* Supports
Development of process improvement activities as identified by
team, manager, or organization expansion.* Serves as a liaison to
other departments.* Assists with Recruitment and hiring for all
direct reports.* Communicates, implements, and follows personnel
policies and procedures within areas of responsibility.*
Coordinates with management when issues arise regarding personnel
policies and procedures and to define staffing and staff
development needs.* Assures adequate staff coverage to meet
business needs, to include consideration and approval of staff
PTO.KNOWLEDGE, SKILLS AND ABILITIES* Knowledge of advanced clinical
standards, practices, and procedures for designated member
population* Knowledge of Medicare, Medicaid, and commercial payor
guidelines* Consistent application of effective team leadership,
mentoring and coaching skills* Demonstrates expertise in the
application of InterQual/Milliman criteria* Knowledge and
understanding of NCQA Guidelines* Consistent application of
effective team leadership, mentoring and coaching skills* Knowledge
of, and skill in, the use of personal computer and Microsoft Office
Suite* Knowledge of age specific communication needs with the
ability to listen actively and respond to internal and external
customers in a timely, competent manner both verbally and
nonverbally* Skill in teaching and nursing process* Ability to make
presentations in a public setting* Ability to maintain professional
demeanor in resolving conflicts* Ability to work cohesively with
team, members, physicians and medical staff to articulate complex
concepts in managed care and coordinated care principles* The
ability to interpret financial cost analysis reportsMINIMUM
QUALIFICATIONSEducation: Licensed Practical Nurse certification or
Associates Degree in NursingExperience:* 2 years' experience in
Utilization Review for Insurance or Community Based facility and/or
experience in care transition management.* 2 years clinical nursing
experienceCertification:* Registered or Licensed Practical Nurse
required with current unrestricted Washington state license.*
Current driver's license
Keywords: Optum, Tacoma , UM Supervisor - Inpatient Services, Other , Tacoma, Washington
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