Supervisor- Utilization/Care Management

Location: METROHEALTH MEDICAL CENTER

Biweekly Hours: 72.00

Shift: day shift 8a-530p

The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County's safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.

Summary:


In cooperation and conjuction with the Director - Care Coordination and Manager - Care Coordination, plans, coordinates, and evaluates all activities impacting utilization review (e.g., the centralized referral/authorization area specifically focusing on payer verification, preadmission processing, authorization, clincial utilization management functions, etc.). Works with the manager to oversee the application of clinical criteria to ensure the correct preauthorization status and level of care. Works with payors and providers to establish/maintain processes that ensures adequate payment of services that is consistent with contractual agreements. Serves as a clinical resource to the physician group and Utilization Management Specialists. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.

Qualifications:

Required: Completion of Bachelors of Science Degree in Nursing (BSN) from an accredited institution within 2 years of hire. Possess a current license to practice as a Registered Nurse in the State of Ohio. 5 years of experience in case management, including using medical necessity criteria such as Milliman Care Guidelines. Strong analytical and trouble shooting skills. Strong written, verbal, and interpersonal communication skills. Preferred: Bachelors of Science Degree in Nursing (BSN) from an accredited institution. Experience working with EPIC/ Case Management modules. Experience as a Supervisor. Physical Requirements: May sit, stand, stoop, bend, and ambulate intermittently during the day. May need to sit or stand for extended periods. See in the normal visual range with or without correction. Hear in the normal audio range with or without correction. Finger dexterity to operate office equipment required. May need to lift up to twenty-five (25) pounds on occasion. Ability to communicate in face-to-face, phone, email, and other communications. Ability to see computer monitor and departmental documents.