UM Clinical Supervisor
It's the new age of independence. And it's changing the way we live. BE PART OF IT.
UNIVITA is dedicated to helping people live and age with independence. By providing a single place to find and manage resources which support independent living, UNIVITA makes it easier to access care and to age safely at home.
This is your opportunity to join an innovative company with a culture that promotes compassion, trust and accountability.
ABOUT THIS OPPORTUNITY This position will provide leadership and supervision to nurses and non-clinical support staff to ensure utilization management and care coordination activities and requirements are fulfilled for the customer and beneficiaries. Responsible for ensuring proper staff training including working in conjunction with management on any training needs relating to the delivery of home health services to assure.
1. Supervises UM Clinical staff and non-clinical support staff including hiring and disciplinary process. Coaches and mentors staff in the delivery of the utilization management process.
2. Oversees the utilization management process of the UM Clinical Specialist nurses including assessment, planning, facilitation, care coordination, evaluation, and advocacy for options to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality outcomes.
3. Oversees the day to day operational workflow of the team, including case loads, assignments and quality of utilization management work. Serves as a point of contact for both internal and external customers for escalations as needed. Elevates concerns to manager in a timely manner.
4. Provides review and/or analysis of available management reports in order to identify potential root causes and makes fact based decisions regarding problem resolution.
5. Identifies, develops, and makes recommendations regarding the on-going needs of the Utilization Management area. Provides input to management toward solution to issues.
6. Acts as the subject matter functional lead to develop new procedures and policies as necessary, as well as reviews and updates existing policies consistently for accuracy. Acts as the subject matter expert for the internal Quality team regarding needed changes to quality, audit or training material. And provides the updates to the staff, agencies and others impacted through training, communication process and /or in services.
7. Educates network providers and Patients on Home Health Standards and guidelines plus performs oversight and audit with orientations to downstream Provider
8. Manages the interface between Univita and the customer; responding to requests for program enhancements, inquiries, audits, compliance issues or other concerns.
9. Oversees process of reviewing requests for coverage of benefits and/or medical necessity. Assures that staff refers cases to the Medical Director per department guidelines.
10. Assists staff interpretation of medical policy and benefit plan descriptions for covered and medically appropriate benefit decisions and overseeing staff that do such
11. Assures the process of timely communication with providers, agencies and the claims payer regarding authorizations and/or denials or additional documentation needs per customer agreements related to service level expectations.
12. Maintains confidentiality and respect of Patient information in accordance with HIPAA, URAC and company standards, policy and procedures
13. Provides proficiency and support in several areas of Utilization Management (UM) processing and support of including claims, appeals for medical, transportation and pharmacy, Hold Harmless, and grievances to assist as needed.
14. Provides leadership and development of customer special programs.
1. Researches latest Medicare and Medicaid guidelines and notifying supervisor if changes need to be made to current policies and procedures.
2. Participates in on-call after hours/ weekend/ holidays support for the department as scheduled and committee work to promote the Quality Improvement (QI) program and other department or company activities
3. Monitors utilization trends and Patient outcomes and reports to supervisors, Providers any instances that do not meet Univita’s Utilization Management Program.
4. This position may require nationwide travel up to 3 – 4 trips per year
5. May occasionally carry a small caseload to remain current with system operation.
6. Other duties as assigned.
• 2 years supervisory or management experience in an operations setting, preferably health plan administration, managed care, or other clinical or health related field.
• Minimum of 2 years experience in care coordination and/or utilization management.
• Minimum of 5 years work experience with older adult population in a community setting, long-term care facility, managed care, or other health related field preferred.
• Current, valid and unrestricted LPN or RN licensure in State of Minnesota required.
• Ability to identify the need for system redesign for improved efficiency and quality, and act as the subject matter expert to outline specifications for upgrades.
• Ability to provide excellent customer service to internal and external customers/clients.
• Ability to provide independent judgment, decision-making and discretion. Ability to participate and provide feedback for hiring, firing, performance management and discipline of the staff and manage 2 or more staff members
• Required to uphold the principles of compliance as outlined in the Code of Conduct and related policies and procedures. Supports and participates in the mandatory Corporate Compliance Program training initiatives on an annual or more frequent basis, as required.
Univita provides home-based care management through specialized support and in-home interventions to people with complex needs. Univita’s comprehensive approach to delivering, integrating and managing home care services, promotes patient independence, improves accountability and lowers health care costs. Univita works with current and emerging population risk managers such as health plans, integrated health systems and physician groups, serving commercially insured working age, Medicare and Medicaid populations. To learn more, visit www.univitahealth.com.
TO LEARN MORE ABOUT US visit univitahealth.com
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Employee Type: Full-Time
Industry: Healthcare - Health Services
Manages Others: Not Specified
Job Type: Health Care
Required Education: Not Specified
Required Experience: Not Specified
Contact: Not Available
What makes our team different?
We stand together across roles and responsibilities.
We work with a common set of values, grounded in innovation, accountability, compassion and trust.
We believe every employee has an important role to play in pursuing our mission and moving it forward.
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If you’re constantly looking for ways to do things differently and make things better, we think a lot alike. We’re looking for big thinkers.
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