WellMed, part of the Optum family of businesses, is seeking a Registered Nurse RN Supervisor Prior Authorization or UM Healthcare to join our team in Texas. Optum is a clinician-led care organization that is changing the way clinicians work and live.As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.The Supervisor of Prior Authorization/Utilization Management Services is responsible for the supervision, evaluation and direction of the Utilization Compliance and Quality Management process. The position will ensure compliance with the utilization management program for all pre service requests and empowers team members through active problem solving and resource direction. The position is a resource for difficult or complex and/or exceptional preauthorization requests. The supervisor successfully impacts assigned team and organization by mentoring those who wish advancement and engages in departmental process improvement teams and activities. In addition, the Utilization Management Supervisor is responsible for timely completion of documentation audits and reviewing and mentoring team members to meet and exceed all documentation compliance standards. This position mentors and trains staff in the completion of timely, accurate um determinations and functions as an advisor to Physicians and lower level utilization management staff.If you are located in Texas and have a Compact licenses, you will have the flexibility to work remotely as you take on some tough challenges.Primary Responsibilities:
Assist in development of training materials; acts as Subject Matter Expert
Fields questions and serves as a resource for Clinicians and non-clinicians Assists with reviews and updates job aids to maximize quality and productivity
Trend, analyze and improve processes and suggests improvements
Supports utilization management operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating)
Oversees utilization management functions and ensure compliance with application of criteria from approved standardized guidelines, government mandated regulations and contractual agreements
Plans, organizes and oversees staff to ensure timely completion of um determinations
Ensures team meets established performance metrics and medical cost reduction goals. Includes timely reporting of monthly metric reports
Adapts and collaborates with management on departmental plans and priorities to address business and operational challenges
Oversees the team’s daily staffing requirements to meet program standards
Implements and interprets organizational policies and procedures, reviews work of staff to ensure that policies and guidelines are appropriately applied
Analyze, communicate results/trends, and collaborate with leaders to develop action plans for key reports: TAT Report, Quality audits and any other additional team specific reports
Tracks and trends outcomes for potential improvements in the utilization management process
Interviews, hires, and retains staff in collaboration with management to meet the needs of the department
Evaluates staff performance and conducts merit increases, and disciplinary actions on staff as needed
Conducts annual evaluations of team members in a timely basis; provides feedback in a constructive manner and respects the confidentiality of personnel issues
Monitors and oversees the reporting of all quality issues to medical management leadership for referral and reporting to health plans as appropriate
Monitors appropriate utilization of resources, overtime, and supplies
Reviews difficult and/or exceptional preauthorization requests while assisting with any escalated issues from providers
Performs all other related duties as assigned
The position requires rotating Saturday shift / Additional Saturday shifts will be required as determined by the business
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications:
Current unrestricted Texas RN license or compact license
5+ years of healthcare experience to include experience in a managed care setting, hospital setting and/or physician practice setting, or similar experience
1+ years of demonstrated supervisory or management experience with responsibility for team performance management
Solid experience with MS office including Word, Excel and Outlook with proficient ability to navigate in a Windows environment
Proven ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public
Preferred Qualifications:
Bachelor of Science in Nursing (BSN) or (4+ additional years of experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)
Proven data mining, analytical and reporting skills with the ability to review and interpret data to make recommendations to leadership
Proven solid organizational skills and multitasking abilities
Ability to travel in and /or out-of-town as deemed necessary by business need
In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone.All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
