Supervisor Utilization Review RN

Job Title

Supervise utilization review for RNs. Oversee processes daily. Guide on complex cases. Identify staff education opportunities. Connect departments through communication.

Essential Functions of the Role

• Supervising Utilization Review Department, assigning tasks, assessing productivity, conducting quality reviews, and advising team on peer-to-peer appeals. Also conducting denial research.
• Collecting data to generate weekly reports that aid in improving staff outcomes and enhancing quality metrics.
• Collaborate with the Medical Director and Care Coordination when patients don't meet criteria. Updating Clinical Resource Manager as needed.
• Assigning daily tasks to staff members to ensure service levels are maintained at an optimal level.
• Monitors daily observation reports to identify and address any potential problems.
• Handling escalations from Utilization Review Nurses and other staff members.
• Conducting quality reviews as needed.
• Responding to inquiries from staff members and stakeholders regarding Utilization Review.
• Serve as a Subject Matter Expert (SME) for Utilization Review workflow issues, complex cases, denials, and customer interactions, both internal and external.

Key Success Factors

• Possessing a helpful nature that assists others in identifying and solving challenges.
• Skilled in mentoring and encouraging colleagues for the enhancement of their clinical proficiency.
• Exceptional written and conversational abilities.
• Proficient at collaborating effectively with employees of varying ranks, including those at the highest level of leadership.
• Familiarity with discharge planning, case management, and utilization review processes, case handling and the review of resource usage.
• Experience in strategically directing work among team members based on established policies and protocols.
• Aptitude in making sound hiring and termination suggestions.
• Proficiency in training colleagues and assessing their performance.
• Basic digital skills like using Microsoft Office, information security, managing schedules and payroll, electronic medical documentation, and email use

Qualification

• EDUCATION - Associate's Degree
• MAJOR - Nursing
• EXPERIENCE - (4) Four Years of Experience