Utilization Management Supervisor

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 12%

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ProgenyHealth, LLC

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

ProgenyHealth, LLC is a company focused on transforming healthcare for women, infants, and families through its integrated Maternity and NICU Care Management solutions. With over 20 years of experience, ProgenyHealth provides a comprehensive care management solution to address the maternity and NICU challenges faced by modern health plans. By identifying risks early, the company aims to prevent preterm births, NICU stays, and complications during pregnancy and after delivery. ProgenyHealth operates as a trusted partner for health plans, overseeing a full maternal and infant care continuum, creating lasting relationships, and optimizing maternal and infant healthcare economics. The company also helps solve non-clinical social drivers impacting maternal and infant health, ensuring equitable, standardized, and predictable family care.

📋 Description

• Manage UM nursing staff in the day-to-day operations of the department • Oversee and adjust work queues as needed to maintain workflow balance • Monitor and implement adherence to department and company metrics • Train new hires and provide ongoing clinical training • Support the clinical nursing staff and company program • Assess the UM program for opportunities to improve efficiencies and outcomes • Report to the Director of Utilization Management • Work closely with management staff • Implement and promote a culture and work environment focused on active, continuous improvement of products and services • Support ProgenyHealth's mission to improve health outcomes of infants in intensive care nurseries through partnership, care facilitation, continuous quality improvement, and commitment to excellence

🎯 Requirements

• 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

• 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