Supervisor Clinical Utilization Management - Health Plans Admin

DescriptionSummary: The Supervisor Clinical Utilization Management is responsible for the clinical coordination and leadership of the Utilization Management, Referral, and Precertification Management information between the UM/CM department and providers. This Job is responsible for clinical evaluation of data, UM clinical evaluation of data and all reporting, and intake data reporting. Requirements include clinical licensure in a related field and the ability to manage, supervise, and orient intake/UM staff. Responsibilities: Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.Supervise the daily operations of the utilization management (UM)/Intake department.Ensure appropriate usage of resources in order to facilitate the UM/Intake process.Assist with ensuring consistent data collection from UM staff that is used to assist the company in achieving corporate goals, and to improve monitoring and reporting in order to meet external requirements.Identify opportunities for process improvements necessary to facilitate department functions.Educate staff as necessary to ensure consistent performance and adhere to standards.Assist UM Manager and Director with coordinating and facilitating system processes with providers, partners, vendors, and subcontractors as necessary.Develop and train intake/UM staff.Manages staff of Intake Coordinators and/or Clinical UM Staff.Monitors caseloads, distribution, and productivity of all Intake Coordinators and/or Clinical UM Staff.Provide Internal Chart Audits.Prepares all Utilization Management reports, letters, and clinical analysis documents as requested.Collaborates with other departments within the organization.Identifies areas of potential improvement in workflow.Receive process and complete data entry of demographic information for all referral and authorization requests from providers via fax or phone and as appropriate, review clinical data and make professional, clinical judgment to forward to precertification nurse/care manager/case manager/medical director as appropriate.Adhere to URAC standards Follow CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPPA).Attend monthly departmental meetings and/or interdepartmental meetings as appropriate.Coordinates work hours of staff including, including scheduling, approving time off requests, tracking absences, timekeeping and managing overtime expenses. Completes Performance Reviews, and provides recommendations and input into other employee reviews and disciplinary processes with staff.Any other duties as directed. Job Requirements: Education/Skills Bachelor’s degree in nursing (BSN) requiredMaster’s degree preferred Experience 3 years of utilization management/quality improvement experience requiredWorking knowledge and understanding of basic utilization management and quality improvement concepts requiredPrevious experience as a lead in a functional area or managing cross-functional teams on large-scale projects required2 years of nursing or other clinical experience in a hospital setting requiredSupervisory experience preferred Licenses, Registrations, or Certifications RN licensure required  Work Schedule: TBD Work Type: Full Time EEO is the law - click below for more information:  https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at (844) 257-6925. Additional Information: - Specialty: RN - Location: 5101 North O Connor BoulevardIrving, Texas 75039 - Contact: About the Company: CHRISTUS Health is an international Catholic, faith-based, not-for-profit health system comprised of more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. Sponsored by the Sisters of Charity of the Incarnate Word in Houston and San Antonio and the Sisters of the Holy Family of Nazareth, the mission of CHRISTUS Health is to extend the healing ministry of Jesus Christ. To support our healthcare ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on staff who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States. EXTENDING THE HEALING MINISTRY OF JESUS CHRIST We are inspired by our mission, vision and core values to deliver compassionate, high quality health care, improving the health of the communities we serve. Above all, we are committed to providing our customers and their family members with a truly unique healing experience, one that embodies our values and respects the dignity and worth of each person. Creating a health care system that is truly excellent in all areas is an ongoing effort.