Utilization Management Supervisor

Company

ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns positively impacting maternal and infant health outcomes across America. Our program builds a network of support for an uninterrupted continuum of care from prenatal health, through any resultant NICU stay, and all the way to one full year of life. Our team of neonatologists, pediatricians, and NICU nurses provide continuity of care in collaboration with providers from hospital to caregivers at home and throughout the first year of life. We help overcome systemic barriers to support healthier pregnancies and healthier starts to life for all moms and babies, one family at a time.

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.

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