Clinical UM Supervisor

Job Description

Clinical UM Supervisor

Lead II – BPM

Who We Are

UST HealthProof is a dynamic company with a mission to lower the cost of care and deliver the future of healthcare. Our consumer-centric approach gives our health plan customers a modern infrastructure and reduced administrative costs, helping to drive better business results for our customers — and better outcomes for our communities.

We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States. **

You Are**

UST HealthProof is looking for a highly energetic and collaborative Clinical UM Supervisor with 3-5 years of Utilization Management experience. This role will report to the Director of Operations for Healthcare Platform Solutions. Candidate should have excellent written and verbal communication skills and ability to liaise with client organizations and multiple stakeholders to be successful in this role. The primary objective of the Clinical UM Supervisor is to foster an environment of excellence in servicing UST Healthproof Healthcare Customers. This includes extensive interaction with client organizations and multiple stakeholders, delivering a high-quality UM operation meeting and exceeding all service level agreements and KPIs, driving operational excellence, and building competencies for delivery. **

The Opportunity**

• Providing utilization management services and providing supervision and leadership.
• Responsible for directly managing a group of 3-10 associates or as defined by the director of operations.
• Manage each team member of the Utilization Management team through frequent communication, case reviews, performance evaluations, onsite assistance, and as a resource as needs arise.
• Responsible for promoting the ongoing development of all staff and maintaining a professional environment in which all staff can thrive and develop.
• Includes ongoing collaboration and communication with providers, clinical staff, case managers, and clients utilizing collaborative decision-making when appropriate.
• Be responsible for day-to-day interaction with client organizations to help run a high-quality UM operation.
• Be responsible for hiring and boarding the operations team, in collaboration with HR.
• Attends and participates in Case Conference on Inpatient and Behavioural Health admissions.
• Performing ad hoc UM functional audits and delegation oversight audits.
• Analyzing data and preparing concise, accurate, and meaningful reports in accordance with UM policies and procedures; defining opportunities for improvement through trend analysis and communicating information appropriately.
• Ensures SLAs are met and reported monthly.
• Lead orientation and training for new Utilization Management staff related to managing role/workflow expectations.
• Perform case reviews of Utilization Management peers evaluating policy/protocol adherence, interdisciplinary team collaboration, and utilization trends of engaged populations.
• Provide peer-to-peer feedback related to productivity and caseload management opportunities.
• Adhering to company policies and procedures regarding confidentiality and privacy.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. **

What You Need**

• Registered Nurse with current unrestricted US Registered Nurse license required.
• 3+ years of direct, clinical nursing experience
• 2+ years’ experience in U.S. Healthcare in Utilization Management, Case Management, or Case Management.
• Strong oral, written, and interpersonal communication skills in English.
• Demonstrate problem-solving skills, facilitation skills, and analytical skills through previous experience.
• MCG Certification will be a plus.
• Healthedge HRCM or Guiding Care experience is a plus.
• Proficient computer skills and experience with Microsoft web-based applications.
• Experience working both independently and, in a team-oriented, collaborative environment.

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by local law, UST provides a reasonable range of compensation for roles that may be hired in California, Colorado, New York, or Washington as set forth below. **

Role Location: Remote

Compensation Range:** $51,000-$77,000

Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits. **

What We Believe**

We’re proud to embrace the same values that have shaped UST HealthProof since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone, to champion diversity and inclusion, and to place people at the center of everything we do. **

Humility**

We will listen, learn, be empathetic and help selflessly in our interactions with everyone. **

Humanity**

Through business, we will better the lives of those less fortunate than ourselves. **

Integrity**

We honor our commitments and act with responsibility in all our relationships. **

Equal Employment Opportunity Statement**

UST HealthProof is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

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