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UM Supervisor - Inpatient Services

Company: Optum
Location: Tacoma
Posted on: January 15, 2021

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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