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RN Supervisor Utilization Management for WellMed - San Antonio, TX
Be a part of a growing team!
This position will have to rotate Saturdays as part of the schedule.
The Supervisor Utilization Management is responsible for utilization management which includes Concurrent Review and Prior Authorizations. (Telephonic Inpatient Care Management).
Performs reviews of current inpatient services. Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit.
- Current unrestricted RN licensure in applicable state.
- Undergraduate degree or equivalent experience.
- Previous supervisory experience
- 2 years managed care experience or 5 years as an RN
- 2+ years previous Utilization Management/Prior Authorization experience
- Good understanding of sorting and filtering data in Excel spreadsheets.
- Working knowledge of Medicare benefits and rules
Preferred Experience and Skills
- Previous Utilization Management Supervisory experience
WellMed is a healthcare delivery system serving more than 90,000 patients, primarily Medicare eligible seniors, in Texas and Florida through primary care clinics, multi-specialty clinics, and contracted medical management services. Headquartered in San Antonio, Texas, WellMed is an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services and more.
Our focus and mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. We are innovators in preventative healthcare, striving to change the face of healthcare delivery for seniors. Our providers and support staff are selected for their dedication to the senior population and focus on preventative, proactive patient care.
WellMed is now part of the OptumHealth division under the greater UnitedHealth Group umbrella.
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
keywords: rn, registered nurse, prior authorization, um, utilization management, rn supervisor, rn manager, sa, san antonio, tx
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Job Category: Nurse
Job Reference Code: UHG-541858
Position Type: Full-Time