Operations Supervisor, Utilization Management

Job Purpose

The Operations Supervisor, Utilization Management is responsible for the supervision activities and operations of the overall functions of the department and staff.

Duties and Responsibilities

• TEAM:
• As leader of his/her team, a supervisor is expected to guide his/her staff in the direction that follows the values set forth by the company – Integrity, Knowledge, Teamwork, Respect, and Service
• Foster a spirit of camaraderie and teamwork among team members, within the team itself and with other teams as well
• Monitor improvement of staff in regard to set productivity and quality metrics by providing timely monthly touch base and quarterly performance review
• Coach and mentor staff members in regards to his/her KPIs: accuracy, efficiency & attendance
• Coordinate with other departments for any recommendations to address staff concerns such as quality, HR and IT concerns
• Find ways and opportunities for growth and excellence
• Address concerns and proffer resolution to individual as well as team issues
• Identify potential leaders and assist in providing the environment to enhance these qualities
• Act as mediator among management, client and staff
• Disseminates changes in coding guidelines, monitoring changes in regulations and policies that impact clinical documentation and reimbursement to assure compliance.
• Make sure that POCs assigned to his/her team are properly guided and monitored for effectiveness
• CLIENT:
• As mediator between client and staff, a supervisor needs to ensure a clear and open communication between the team and the client
• Ensure that guidelines and metrices are understood and followed to meet client satisfaction
• Address any issues or concerns the client may have and ensure that the Coding Manager is looped in on all conversations
• Moreover, address any issues or misunderstanding the staff may have in the event new guidelines are set forth by the client
• Monitor that client systems and applications are in optimal performance to ensure timely submission of all deliverables
• Coordinate with the client and their designated helpdesk of any issues and concerns that prevented the team in meeting expected productivity outcomes
• Address any quality concerns brought about by the client with the concerned staff and coordinate this with the QA and Training team as needed
• Ensure that proper onboarding is conducted to a new staff prior to live production to ensure correct understanding of client guidelines and quality metric is constantly met
• Regularly participate in client calls to build rapport with the client, to ensure understanding of any issues and concerns raised, and to communicate and clarify any staff concerns
• Provide client updates with production and quality report on a monthly or as requested basis
• Maintain a daily productivity report for review
• MANAGEMENT:
• As mediator between senior management and the staff, a supervisor will need to ensure all communication and directives coming from senior management shall be relayed to all concerned staff in a timely manner
• Sees to it that there is strict staff adherence to company policies and rules and regulations
• For proper dissemination of information, a supervisor should have a deep understanding of company policies as well to address all staff concerns with regards to such policies and to ensure proper channeling of any issues and concerns
• To address management concerns as appropriate
• Ensure proper and timely documentation of daily productivity to determine meeting of metrics and deliverables
• Assist in his/her own capacity through feedbacks and suggestions on how to improve current policies impacting staff and employees as a whole
• Monitor all disciplinary processes pertaining to staff for appropriate guidance
• Participate on all meetings set by senior management as called for
• Coordination with HR/Work Force Management for the attendance schedule and staffing of the team
• In the event that the account is with backlog or needed additional support, the supervisor is expected code for production or audit charts as necessary to support the team

Qualifications and Education Requirements

• Bachelor's Degree in Medical or Allied Medical courses or equivalent in relevant clinical work experience.
• With previous supervisory, team lead or POC experience
• At least 2 years' experience as a Utilization Review Nurse
• In-depth knowledge in using InterQual and Epic
• At least 1 year of experience in a similar capacity – e.g. POC, SME
• Clinical experience a must thereby must be a Registered Nurse
• Efficient in Microsoft Office (such as Excel, Power Point presentation and Word applications)
• Above average analytical skills.
• An understanding and strict adherence to all HIPAA regulations
• Ability to work in a team-fostered environment and have the willingness to adjust to changing job responsibilities, shifting schedules, new procedures and unexpected workloads and stresses.
• Possess strong verbal, written communication, interpersonal skills and analytical skills
• Assertive self-starter who can work independently, yet function in a team environment
• Positive attitude and professional client interaction.
• Ability to maintain the highest level of confidentiality and professionalism.
• Ability to work in a multi-tasked environment.
• Ability to adapt to a flexible schedule.

Work Environment

• Remote; Office environment as called for, e.g. townhalls and onsite activities
• Work Schedule: Dayshift, willing to work on weekend

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.