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Util Review Mgmt Supervisor
at Sedgwick CMS in Texas
Utilization Review Management Supervisor
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice® designation. Come be a part of our team and "Claim Your Future."
PRIMARY PURPOSE:
To provide services for dedicated accounts; to ensure the efficient, cost effective, and high quality delivery of utilization review service by supervising and training a staff of registered nurses; to oversee the management of medical cases worked by registered nurses; to oversee individual and overall results/outcomes of all cases within their scope of responsibilities; and to ensure customer satisfaction through the provision of cost effective and high quality utilization review service that meets their needs.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES:
Trains and develops utilization review staff.
Supervises a team of nurses ensuring utilization management services are delivered promptly, cost effectively, courteously, and according to legal requirements, operational, and quality assurance standards.
Takes corrective action when necessary ensuring objectives, standards, policies and procedures are met.
Works with program manager to establish and ensure achievement of office/unit customer service, utilization patterns, productivity, quality and financial goals.
Ensures that staff adheres to quality assurance and productivity standards: assists program manager in evaluating customer service utilization patterns, productivity, quality and financial results ensuring that service delivery is within parameters defined by the company.
Performs active customer service function for account; provides day-to-day contact with customer to resolve service delivery problems/issues; responds to customer requests; communicates any special customer instruction or procedure that must be adhered to by the registered nurse.
Advises staff of any pertinent changes in customer service delivery, regulatory mandates or business functions; provides training on regulatory issues.
Makes recommendation for ongoing and future service delivery options; identifies referrals for case management.
Maintains a quality assurance program to support the Total Performance Management initiative and the delivery of quality claims service consistently.
SUPERVISORY RESPONSIBILITIES:
Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
Interviews, hires and establishes colleague performance development plans; conducts colleague performance reviews.
Provides support, guidance, leadership and motivation to promote maximum performance.
QUALIFICATIONS:
Education & Licensing:
Baccalaureate degree from an accredited college or university preferred. RN license required. CPUR or other related designation required.
Experience:
Five (5) years of clinical practice experience including two (2) years supervisory experience required.
Skills & Knowledge:
Strong knowledge of utilization review practices
Expert knowledge of the insurance industry and claims processing
Acquired knowledge of GM claims process, plan design and customer needs
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Leadership/management/motivational skills
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT:
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
License or Certification(s) Required or Preferred: RN required, certification CCM preferred
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://sedgwickcms.contacthr.com/18509500
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice® designation. Come be a part of our team and "Claim Your Future."
PRIMARY PURPOSE:
To provide services for dedicated accounts; to ensure the efficient, cost effective, and high quality delivery of utilization review service by supervising and training a staff of registered nurses; to oversee the management of medical cases worked by registered nurses; to oversee individual and overall results/outcomes of all cases within their scope of responsibilities; and to ensure customer satisfaction through the provision of cost effective and high quality utilization review service that meets their needs.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES:
Trains and develops utilization review staff.
Supervises a team of nurses ensuring utilization management services are delivered promptly, cost effectively, courteously, and according to legal requirements, operational, and quality assurance standards.
Takes corrective action when necessary ensuring objectives, standards, policies and procedures are met.
Works with program manager to establish and ensure achievement of office/unit customer service, utilization patterns, productivity, quality and financial goals.
Ensures that staff adheres to quality assurance and productivity standards: assists program manager in evaluating customer service utilization patterns, productivity, quality and financial results ensuring that service delivery is within parameters defined by the company.
Performs active customer service function for account; provides day-to-day contact with customer to resolve service delivery problems/issues; responds to customer requests; communicates any special customer instruction or procedure that must be adhered to by the registered nurse.
Advises staff of any pertinent changes in customer service delivery, regulatory mandates or business functions; provides training on regulatory issues.
Makes recommendation for ongoing and future service delivery options; identifies referrals for case management.
Maintains a quality assurance program to support the Total Performance Management initiative and the delivery of quality claims service consistently.
SUPERVISORY RESPONSIBILITIES:
Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
Interviews, hires and establishes colleague performance development plans; conducts colleague performance reviews.
Provides support, guidance, leadership and motivation to promote maximum performance.
QUALIFICATIONS:
Education & Licensing:
Baccalaureate degree from an accredited college or university preferred. RN license required. CPUR or other related designation required.
Experience:
Five (5) years of clinical practice experience including two (2) years supervisory experience required.
Skills & Knowledge:
Strong knowledge of utilization review practices
Expert knowledge of the insurance industry and claims processing
Acquired knowledge of GM claims process, plan design and customer needs
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Leadership/management/motivational skills
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT:
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
License or Certification(s) Required or Preferred: RN required, certification CCM preferred
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://sedgwickcms.contacthr.com/18509500
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