Outpatient UM Supervisor (Non-Clinical)

Summary

Reporting to the UM Senior Supervisor (Non- Clinical), the non-clinical UM Supervisor is responsible for planning, organizing, and monitoring the daily operations of the Outpatient Utilization Management team. The supervisor ensures authorizations are processed timely within the State and Federal mandates, while ensuring high quality medical care to our members and providers.

Duties and Responsibilities:

• Lead the interviewing and selection process for new candidates.
• Oversee orientation and ongoing education programs for new hires and existing team members.
• Evaluate staff performance, provide constructive feedback, and implement coaching when performance issues arise.
• Supervise and delegate work; mentor staff and provide opportunities for professional development and growth.
• Conduct research, analyze data, and prepare reports to support audits and regulatory activities.
• Monitor authorization activity and trends to assess staffing needs and ensure departmental efficiency.
• Coordinate auditing and logging of identified errors to support quality improvement.
• Provide oversight, training, guidance, and support to staff.
• Oversee and assist in resolving issues escalated by UM Leads.
• Participate in leadership and required sub-team meetings.
• Provide coaching, feedback, and direction to UM Lead Coordinators; conduct weekly meetings with Leads.
• Assist in the development and implementation of standard operating procedures, job aids, policies, and workflows aligned with departmental and organizational priorities.
• Review and approve policies and procedures (P&Ps) to ensure alignment with regulatory, contractual, and organizational standards.
• Build and maintain a team recognition program; recommend team members for Core Value awards.
• Identify opportunities to strengthen provider networks by addressing vendor and specialty gaps.
• Complete annual staff performance evaluations and provide formal feedback.
• Monitor reports and dashboards to ensure workflows are completed timely and accurately.
• Collaborate with SOPI on project management requests.
• Oversee onboarding and monitoring of Calibrated staff.
• Validate reporting prior to Health Plan/Client submission to ensure accuracy.
• Perform other duties as assigned and deemed necessary to support departmental and organizational needs.

Minimum Job Requirements:

• Bachelor’s degree or an equivalent combination of education, training and experience as a Financials or Business Analyst is required.
• Project Management Professional (PMP) certification is a plus.
• Proven experience in project management.
• Ability to lead project teams of various sizes and see them through to completion.
• Strong understanding of formal project management methodologies.
• Experience as a project manager, IT project manager or ERP project manager is required.
• Understanding of ERP implementation.
• 3+ years of Physician Organization or Health Plan, Hospital Finance and/or Health Plan experience (operations, objectives, processes and information flow).
• Strong understanding and experience of project management software: Smartsheet & Blackline
• Smartsheet Project Management Certification required
• Strong understanding of SQL database management, Sage100, EZ-Cap, MS Power BI and Tableau is a plus.

Skills and Abilities:

• Ability to successfully handle multiple, high urgent request in timely manner
• Reliable, dependable, and accountable
• Well-developed written and Verbal communication
• Time management and adaptability Skills

Salary Range:

• $92,550 - $110,000 annually