Supervisor-Utilization Review/Full Time/Remote

General Summary

The Supervisor of Utilization Management has an important role in a high-profile group tasked with implementing system-wide improvements and operational processes to ensure optimal and compliant utilization review strategies. Under minimal supervision from the Manager the Supervisor is responsible for monitoring productivity and ensuring the day-to-day tasks are completed in a timely fashion. Responsibilities include personnel management, communication with key stakeholders (both within the centralized unit and local sites), dashboard and reporting development, and working closely with leadership to drive progress toward system goals. This position requires strong interpersonal and communication skills and well-developed analytic and organizational skills and must be able to work effectively with leaders at all levels of the organization. Flexibility, innovation, and creativity are necessary characteristics of the successful candidate. Expectation is to learn and apply new continuous improvement methodologies, and to spread successful innovation throughout the institution.

Principle Duties And Responsibilities

• Coordinates in conjunction with leadership on the planning, organizing,
  
  

implementation and evaluation of workflows and team member engagement daily.

• Working with key clinical, operational, and payer stakeholders, manages day to day
  
  

activities to ensure complete and accurate capture of inpatient status and revenue

from government and commercial payers.

• Working with key revenue cycle and business unit leadership, aids in the
  
  

development and execution of projects to ensure standardized approach to inpatient

status determination.

• Develops and assists to oversee strategies for multi-disciplinary projects to ensure
  
  

the system achieves successful revenue realization in initial status determination

and denials.

• Assists in the development of dashboards, KPI’s, misc. reporting, and other tools to
  
  

understand and communicate performance to the health system; engages analytical

staff in the development of these tools.

• Researches best practices, including implementation of new products or systems,
  
  

for and oversees projects to incorporate identified best practices into process

design.

• Works with staff to assess organizational performance (e.g., a function, a
  
  

department, a key process, etc.) in relation to established goals and standards;

recommends new approaches, policies, and procedures to effect continual progress

toward goals and standards.

• Develops skills that provide assistance and serve as a resource to departments and
  
  

business units in identifying, planning, and implementing improvement initiatives with

alignment to System goals.

• Manages day to day program operations; recruit, hire, and onboard new staff as appropriate.
• Assigns, distributes, and reviews work assignments, ensuring timely and accurate completion.
• Identifies staff development needs and opportunities for improvement or enhancements of skills, coaches’ staff in areas of professional development.
• Performs all aspects of personnel management including mid-year and year end performance appraisals, policy and procedure adherence, corrective action, and termination if warranted.
• Demonstrates to others the incorporation of Henry Ford Health Team Standards and Mission, and Vision Statement into daily activities.
• Actively seeks opportunities for self-improvement through self-awareness and feedback.
• Actively pursues opportunities to become multi-skilled to serve a more diverse role in the organization, with developing skills in organizational improvement and business
  
  

Education/Experience Required

• Registered Nurse with valid unrestricted Michigan license.
• Bachelor’s Degree in Nursing or Associate Degree in Nursing plus four (4) years’
  
  

experience in a healthcare related field.

• Four or more years of experience in a hospital, health insurance, or other health
  
  

care agency setting required, with at least one year of experience in project

management, revenue cycle, and /or clinical operations preferred.

• Strong leadership/mentoring skills applicable to both inter-departmental staff and
  
  

multi-disciplinary teams.

• Knowledge of Medicare, Medicaid, Blue Cross and other third-party payers billing
  
  

and reimbursement regulations/policies, preferred.

• Demonstrates fluency in healthcare financial management and revenue cycle
  
  

management best practices.

• Exceptional detail orientation and project management skills; ability to estimate time
  
  

frames and meet projected deadlines; ability to manage large, complex,

simultaneous assignments with potentially conflicting priorities and deadlines.

• Excellent communicator – able to express complex ideas clearly and effectively to a
  
  

varied audience, including the ability to teach complex technical/analytical concepts

to System leadership, management, and staff.

• Foundational knowledge of analytical/technical, facilitative, and process
  
  

improvement knowledge.

Certifications/Licensures Required

Registered Nurse with a valid, unrestricted State of Michigan License.

Additional Information

• Organization: Corporate Services
• Department: Ascension Central Util Mgt
• Shift: Day Job
• Union Code: Not Applicable