Medical Management - Supervisor Complex Utilization Management & Population Health Management

Job Title

Responsible for supervising and coordinating daily workflow and leadership of staff. Activities include developing operating procedures and managing personnel and resources.

Key Responsibilities

• Serves as a resource to the department staff by providing technical direction and resolving workflow problems or improvement opportunities within the department.
• Oversees the PHM team, supporting the development and implementation of care coordination, chronic disease management, and complex case management initiatives. Ensures regulatory requirements are met.
• Assesses individual workload and staffing patterns. Selects, assigns, and evaluates personnel, and recommends or initiates associated personnel actions. Takes caseload as needed to assist with staffing needs. Ensure authorization timeframes and regulatory requirements are met.
• Interviews, hires, trains, and reviews all eligibility personnel in addition to problem-solving and disciplinary actions. Participates in analysis of current policies and procedures and in the development of new or updated standard operating procedures and workflows.
• Attends departmental, interdepartmental, and facility meetings as needed.
• Performs other duties as assigned.

Qualifications

• Ability to plan, organize, schedule, and effect procedural changes.
• Ability to effectively lead, direct and supervise others.
• Ability to reason logically and to use good judgment when interpreting materials or situations.
• Ability to work quickly and accurately with quantitative information.
• Ability to organize time effectively and set priorities.
• Possess strong written and oral communication skills.
• Proficient in Microsoft applications.
• Knowledge of managed care and benefit plans.

Education/Experience

• Graduate from accredited School of Nursing.
• Current, active, unrestricted license to practice as Registered nurse (RN) in the State of Oklahoma.
• At least three years of clinical nursing experience in an acute care setting.
• 2 years of management experience preferred.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin