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Supervisor, Clinical Services Utilization Management Inpatient Services - FT/Days

Company: MemorialCare Health System
Location: Fountain Valley
Posted on: November 23, 2020

Job Description:

Supervisor, Clinical Services Utilization Management - Inpatient Services - FT/Days MEM Position Summary Under the guided support of the Manager/Executive Director of Utilization Management, Inpatient Services, this position has the responsibility for the day to day operations of Clinical Services, Utilization Management Inpatient Services for all hospital campuses. The incumbent shall plan, organize, direct and evaluate people and activities for the department to maximize medical necessity review compliance, clinical authorizations, billing compliance and appeals. The position requires working with inpatient case management, PFS, Patient Access, HIM, external payors, Managed Care, the aligned Medical Directors and other identified leadership to achieve the overall strategic goals of the department as it relates to the cost-effective utilization management processes that supports patient care while maximizing the revenue cycle rendered by providers to patients with in each inpatient hospital service of MemorialCare. The incumbent is an expert-level clinician that supervises and assists when necessary per the requirements of the Supervisor-Clinical Services Utilization Management Inpatient Services job description and standard work for the Utilization Management-Inpatient Services. In addition, the Supervisor-Clinical Services Utilization Management Inpatient Services responsibilities include input into the assessment, planning, implementing and evaluation of individuals, standard work and processes of an assigned team to ensure consistent high-quality, cost-effective patient care. The Supervisor is responsible for coaching, auditing and coordinating standard work of the assigned team. The success of the Utilization Management Inpatient Services team is inherent in the incumbent's ability to demonstrate positive, professional communication with patients, physicians, departmental and interdepartmental staff to optimize workflow and to facilitate problem identification and resolution. Principal Duties and Responsibilities: The Supervisor-Clinical Services Utilization Management Inpatient Services reports to the Manager of Utilization Management, Inpatient Services for establishing, maintaining and continuously improving processes required to achieve the defined scopes of the clinical teams of inpatient utilization management as well as direct management and training of the inpatient utilization management team of Utilization Management-Inpatient Services for all hospital campuses. - Adding to the general fiscal health of MHS entities as subject matter expert for authorization, billing compliance and appeals processes by promoting utilization management processes that provide authorizations, billing compliance and appeals support. - Responsible for participation and guidance of the Utilization Management Inpatient Services department and reports Quality Management activities to the hospital Utilization Management Committees and the Quality Councils. - Responsible for the supervision of operations and management of the team assigned within the Utilization Management Inpatient Services department, including monitoring and reporting as required by regulation or contract. - Responsible for supervising the Clinical Service Teams of Utilization Management Inpatient Services which may include, but not limited to the following positions: RN Lead Case Manager, Utilization Review Assistant, Utilization Review Specialist, Utilization Review Professional, Utilization Management Case Management RN, and Data Coordinator. - Formalize administrative care coordination and utilization management processes, roles, team evaluations, department budget responsibilities, policy and procedures, and continuously update documents as improvements are implemented under the guidance of the Executive Director of Utilization Management. Job Qualifications - Minimum of 2 or more years of supervisory experience in utilization management, care management, health plan, or healthcare equivalent - RN or related field (ie. PA, Medical Degree) preferred - Strong Inpatient, Managed Care and Population Health background - Exceptional verbal, written and critical thinking skills - Proficiency in Microsoft Word suite, Electronic UM/CM Medical Records platform (Epic, Next Gen, Sunrise or like) and other Analytic tools (ex- Health Catalyst) - Work experience applying evidence-based criteria (i.e.: MCG, lnterqual); Health plan medical policy / clinical coverage guidelines. - Knowledge of CMS and Medi-Cal (Centers for Medicare and Medicaid Services) coverage policies required. United States-California-Fountain Valley Management, Administration MemorialCare Health Services Full-time Regular Assistant Unit Manager/Supervisor Nov 10, 2020, 9:09:40 AM 8/80 work shift hours (hospital) Day Job 8a 430p Utilization Management

Keywords: MemorialCare Health System, Fountain Valley , Supervisor, Clinical Services Utilization Management Inpatient Services - FT/Days, Executive , Fountain Valley, California

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