Supervisor of Utilization Management/CM

Job Summary

The Supervisor provides day-to-day operational support for Transitional Care and Complex Care Management teams, focusing on coordinating work schedules, ensuring policy compliance, and monitoring the quality of care delivered to members. This role supports the implementation of processes designed to improve health outcomes, reduce healthcare utilization costs, and facilitate effective care transitions for complex populations. The Supervisor works closely with the Director/Manager, Shared Services, Medical Center, and other stakeholders to ensure a seamless continuum of care across inpatient, ambulatory, and community-based settings. As a liaison between staff and management, the Supervisor facilitates communication and supports efficient team operations. Additionally, the Supervisor assists with performance evaluations and handles certain disciplinary actions, collaborating with the Manager/Director to uphold a high standard of service. Success in role is measured by meeting and/or exceeding KPI targets around Admissions/1000, Readmissions/1000, Average length of stay and ED Utilization.

Duties and Responsibilities

Team Supervision and Support

• Supervises Transitional Care Managers/Care Navigators team members, Complex Care Manager Teams
• Assists with staff development and ensure adherence to care management and Transitional Care Management standards, including person-centered care planning and documentation protocols.
• Ensures Huddle Meetings are effective, efficient and engaging, focusing on identification of member risks, actions to be taken to mitigate risks and closing the loop. Conducts member assessment and care plans audits, one-on-one coaching/training to maintain quality and compliance with regulatory standards, and policies and procedures.
• Supports team members with caseload management to ensure timely documentation and adherence to organizational and health plan requirements.
• Assists with Interviewing, hiring new clinical team staff, and conducts regular 1:1 meetings and performance reviews to optimize performance
• Assists with Prioritization of members and focus for the team
• Provides timely training and meeting updates then ensures team member understand an incorporate changes are into their work
• Fosters strong teamwork among the teams and a culture of accountability to members and each other
• Reviews program KPIs with team members and if performance is on track, celebrates wins, if performance is not on track, initiates root cause analyses and corrective action plans as needed.

Interdisciplinary Coordination

• Facilitates coordination with community organizations, primary care providers, and specialists to address members' chronic care needs and facilitate smooth transitions of care.
• Partners with inpatient case management for collaborative discharge planning.
• Assists in hosting and documenting interdisciplinary care team (ICT) meetings to support effective member outcomes.

Performance Monitoring and Improvement

• Utilizes data and reporting to monitor team performance and identify opportunities for improvement in health outcomes and member satisfaction.
• Uses professional develop plans as a coach document as needed to enhance a tema members’ performance
• Work closely with the manager to implement performance improvement plans for staff as needed.

Member Engagement and Case Management Support

• Act as a resource and support for team members in managing complex cases, addressing members' medical, behavioral, and socioeconomic needs through best practices and therapeutic approaches.

Stakeholder Relationship Support

• Supports the manager/director in maintaining relationships with payors, community organizations, and facility leadership to address barriers such as housing, food security, and financial instability.
• Works collaboratively with MET and Medical Director to optimize member outcomes

Onboarding, Training, and Staff Engagement

• Assist the manager in onboarding, training, and development for new team members. Play a key role in Chapters 3 and 4 onboarding for new hires.

• Support team meetings and contribute to building team morale and productivity.

Additional Responsibilities

• Ensure the privacy and security of member information in compliance with organizational and legal standards.

• Support flexible and innovative solutions to meet changing business needs and priorities.

• Will participate in national meetings focused on how Lead positions function within the organization.

• Will need to be a true subject matter expert in our EHR/EMR systems and also understand our workflows.

Minimum Qualifications

Licensure and Education

• Minimum Education: Associate degree
• Minimum License: Current, Registered Nurse active, and unrestricted license is required

• Minimum Certifications: Qualified with Case management certification or equivalent, strongly preferred

• BLS/CPR required.

Experience

• 5-7 years of experience in care management, preferably with at least 2-3 years in a supervisory role, ideally in Value-Based Care, Utilization Management, or Complex Care Management.

• Familiarity with hospital inpatient stakeholders and EMRs

• Familiarity with complex populations (Medicaid, Medicare, dual-eligible individuals) and experience with medically complex, trauma-informed care experience, behavioral interviewing, and socially vulnerable individuals.

Technical Skills

• Proficiency with Microsoft Office Suite (Word, Excel, Teams) Adobe PDF, Care Management Systems and electronic health record (EHR) systems.
• Strong analytical skills to support performance monitoring and improvement initiatives.
• Familiarity with AI tools and capabilities – CoPilot, CHATGPT

Interpersonal and Communication Skills

• Strong verbal and written communication skills for effective interaction with team members, members, families, and interdisciplinary teams.
• Ability to promote teamwork, manage change effectively, and make sound judgments.
• Ability to coach and mentor team members to achieve optimal performance

Working conditions

This job operates in the community and within a professional office environment. This role requires reliable transportation to commute back and forth between inpatient facilities and office; and routinely uses general office equipment. This role requires a dedicated, quiet workspace with the ability to adhere to HIPAA and other privacy policies. A reliable and high-speed Wi-Fi connection or home internet is required to perform the essential functions of this role. Use of personal vehicles is required for daily community travel.

Ability to travel regionally and nationally up to 80%

Physical requirements

• Ability to operate computer, keyboard, copy and fax machine, phone, and other general office equipment.
• Ability to occasionally move objects up to 20 lbs.
• Valid driver’s license with automobile insurance, with ability to travel up to 80% within the local area.

• Reliable transportation.

Direct reports

(Lead) Transitional Care Manager, (Lead) Center Care Manager, Community Team Care Manager , Transitional Care Associates