Supervisor Utilization Management I
Molina Healthcare - Albuquerque, NM

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Supervisor Utilization Management I

JOB SUMMARY
Oversees the integrated Care Access and Monitoring team responsible for prior authorizations, inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Monitors information daily as appropriate including member metrics and staff productivity. Evaluates the services provided and outcomes achieved by the team and recommends enhancements and/or improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines in day-to-day activities.

ESSENTIAL FUNCTIONS
Duties and Responsibilities
• Oversees, coordinates and monitors all Care Access and Monitoring clinical and non clinical team activities to facilitate integrated proactive utilization management.
• Functions as hands-on supervisor for daily integrated Care Access and Monitoring activities.
• Manages and evaluates team members in the performance of various utilization management activities.
• Performs and promotes interdepartmental integration and collaboration to enhance the continuity of care including Behavioral Health and Long Term Care for Molina members.
• Ensures adequate staffing and service levels, and maintains customer satisfaction by implementing and monitoring staff productivity and performance indicators.
• Collates and reports on Care Access and Monitoring statistics including plan utilization, staff productivity, cost effective utilization of services, management of targeted member population, and triage activities.
• Maintains effective team member relations.
• Conducts regular staff meetings (at least monthly).
• Assists with selection, orientation and mentoring of new team members.
• Conducts performance evaluations in a timely manner.
• Provides coaching, counseling and employee development and meets individually with staff at least monthly.
• Recognizes exceptional employee performance.
• Completes quality audit reviews for all clinical / non-clinical staff.
• Assists team members in improving skills, creativity and problem solving.
• Collaborates with and keeps the Manager of Healthcare Services appraised of operational issues, staffing, resources, system and program needs.
• Manages and completes assigned work plan objectives and projects on a timely basis.
• Participates in committees, task forces, work groups and multidisciplinary teams as needed.
• Maintains professional relationships with provider community and internal and external customers while identifying opportunities for improvement.
• Oversees staff activities to ensure compliance with regulatory and accrediting standards.
• Creates and ensures timely and accurate reporting to Healthcare Services management and appropriate committees.
• Conducts self in a professional manner at all times.
• Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.
• Acts as an information and problem solving resource for Care Access and Monitoring team member.
• Interacts with medical directors regularly, as necessary.
• Facilitates open and timely communication between team members, other Molina employees and external customers.
• Complies with required workplace safety standards.

Knowledge, Skills and Abilities
• Demonstrated ability to communicate, problem solve, and work effectively with people.
• Skilled at supervising high functioning multidisciplinary teams.
• Able to use effective management principles.
• Excellent organizational skills with the ability to manage multiple priorities.
• Work independently and handle multiple projects simultaneously.
• Knowledge of applicable state, and federal regulations.
• In depth knowledge of Interqual and other references for length of stay and medical necessity determinations
• Experience with NCQA.
• Knowledge of state/federal regulatory requirements.
• Ability to take initiative and see tasks to completion.
• Computer Literate (Microsoft Office Products).
• Excellent verbal and written communication skills.
• Ability to abide by Molina’s policies.
• Ability to maintain attendance to support required quality and quantity of work.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.
• Other duties as assigned.

QUALIFICATIONS
Required Education:
• Bachelor’s degree in health related field (equivalent combination of experience/education will be considered in lieu of Degree).

Preferred Education:
• Master’s degree in Health Care Administration, Public Health or related field.

Required Experience:
• 3+ years of managed care experience and 2+ years of utilization management experience; and at least one year of healthcare supervisory experience.

Preferred Experience:
• 3+ years in a supervisory role in a Managed Care Environment

Preferred Licensure/Certification:
• Utilization Management Certification (CPHM), Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification

To all current Molina employees if you are interested in applying for this position please fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online. Be sure to let us know you are a current employee by selecting “Molina Employee (current) in the source section of the online application.
Molina Healthcare offers competitive benefits and compensation package.
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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