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The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Utilization Management Supervisor to supervise the clinical and non-clinical staff day to day operations. Assist in triaging/and or resolving identified issues/problems and form resolution within scope of work as well as escalate the appropriate issues to the Health Services Utilization Manager, as needed. The Supervisor will assist in the development of a successful and cohesive unit, with high level of productivity and accuracy to achieve the Health Services department's overall performance metrics.
The essential duties and responsibilities will include the following:
Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and implementing corrective action steps when necessary; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards. Complete performance evaluations in a timely manner.
Maintain and provide efficient backup coverage to ensure achievement of all internal and external needs. This includes tasks such as creating, delegating, and directly managing special projects, audits and reports for the department.
Continuously monitor Utilization Management activity and analyze all opportunities especially in providing recommendations to improve efficiency and reduce costs. This may include identifying and undertaking a variety of special projects aimed at increasing effectiveness and finding efficiencies; also participates on cross-functional teams that help further operational success.
Answer questions from Members and Providers and resolve issues promptly as they relate to Utilization Management staff assignment and duties. Provide ongoing technical support for staff.
Supervise telephone encounters conducted by Utilization Management staff. Provide first line of support for escalated calls which include internal and external customer support issues.
Continuously improve services with both internal and external customers. This includes investigation and response to Member complaints, implementing necessary improvements to avoid reoccurrence, and training staff on new processes, as needed.
Act as a resource person for questions regarding Prior Authorization for Employees, Members and Providers, including but not limited to authorization requirements, clinical documentation and additional resources available in the community.
Ensure that staff enters required data in selected database sources using the correct template and the appropriate language with accuracy and in a timely manner.
Assist the Utilization Manager with the development and operation of Quality Assurance programs across clinical and non-clinical staff scope of practices in order to develop and retain Best Practices and service quality outcomes.
Assist Utilization Manager in the identification of training needs including but not limited to the development of educational programs, training materials, competency checklists, and orientation checklists necessary to meet professional improvement needs of the Utilization Management staff. This will also include training and cross training of current and new employees.
Analyze new or updated regulations, laws and contract language and implement appropriate changes to internal policies, procedures and workflow.
Requirements
Education and Experience: Bachelors degree in nursing; a Masters degree is preferred. Three (3) years of supervisory experience in a health care and/or managed care environment. Experience with Medicare-SNP programs preferred.
Knowledge of: Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint. Health Care Coordination and/or Health Care Case Management models. Supervisory principles and practices as well as techniques and methods to organize and manage direct reports.
Ability to: Work cooperatively with others. Work as part of a team and support team decisions. Communicate effectively, both verbally and in writing. Adapt to changes in requirements/priorities for daily and specialized tasks. Provide supervision and guidance to a multidisciplinary group of staff. Plan, organize, and prioritize own work and that of the unit as directed by the Manager; meet deadlines. Develop and maintain effective interpersonal relationships with others, including providers, members, community partners, public agencies, and government programs. Communicate effectively, both orally and in writing. Demonstrate excellent detail oriented organizational, time management and interpersonal skills. Think and work effectively under pressure and accurately complete tasks within established times; prioritization and meeting critical deadlines. Ability to solve complex issues and identify and implement creative solutions. Possess strong interpersonal skills including coaching staff, and handling conflict resolution.
Compensation and Benefits
Starting Compensation Range: - Depending on Experience
Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employees Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.
How to Apply
Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: careers@hpsm.org or via fax: (650) 616-8039. File by: Continuous until filled. The Health Plan of San Mateo is proud to be an Equal Opportunity Employer and encourages minority candidates of all backgrounds to apply.
Submissions without a Cover Letter and Salary Expectations may not be considered.
