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Indiana University Health

Supervisor-Utilization Management

System Clinical Services
Date Posted
17 September, 2021
Schedule & Shift
Full Time
Day
Requisition Number
317012
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Supervisor-Utilization Management

Job Description

Overview

Functions as a hands-on working supervisor ensuring productivity, coordinating, and monitoring clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards. Manages and evaluates team members in the performance of various utilization management activities; provides coaching, counseling, employee development, and recognition; and assists with selection, orientation and mentoring of new staff. Completes staff quality audit reviews. Evaluates services provided and outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines. Prepares utilization management reports for monthly medical staff meetings. Identifies root cause of initial and continued stay denials and works in collaboration with physicians and other departments to implement process and system improvements. Develops strategies to decrease denials, length of stay, observation hours, inappropriate admissions, avoidable days and to achieve expected length of stay benchmarks in MCG guidelines. Updates scope of work standards and ensures corrective action plans are implemented by staff. Performs and promotes interdepartmental integration and collaboration to progress care and meet department goals. Willingly and consistently offers to help those who are experiencing high volume UM caseloads. Annually evaluates staff on job performance and updates payer requirements with revenue cycle and centralized UM. 

  • Current licensure as a Registered Nurse in the State of Indiana. 

  • Requires an Associates of Nursing (ASN); Bachelor of Nursing (BSN) preferred.

  • Requires that the RN has graduated from a nationally accredited nursing program.

  • Requires 3-5 years of relevant clinical experience. MCG Certification preferred.

  • Utilization management experience preferred. 

  • Requires Basic Life Support certification through the AHA.

  • Proven Leadership and organizational skills are preferred.

  • Proficient in Microsoft Office and applications.

  • Requires basic understanding of Medicare/Medicaid, insurance, and regulatory guidelines.

  • Requires computer proficiencies to enter and retrieve data, to assemble and organize data, to use, analyze, and integrate data from diverse sources

#LI-ML1

 

 

Safeguarding our patients and each other is an important part of how we deliver the best care possible to the communities we serve. As a condition of employment, IU Health requires all new hires to receive various vaccinations, including the influenza and COVID-19 vaccines, barring an approved exemption. New hires will also be provided the option to submit proof of previous vaccination. The COVID-19 vaccine is not required to begin employment; however, all team members need to be fully vaccinated by September 1, 2021.

We are an equal opportunity employer and value diversity and inclusion at IU Health. IU Health does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.

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Indiana University Health is Indiana’s most comprehensive health system, with 16 hospitals and more than 34,000 team members serving Hoosiers across the state. Our partnership with the Indiana University School of Medicine gives our team members access to the very latest science and the very best training, advancing care for all. We’re looking for team members who share the things that matter most to us. People who are inspired by challenging and meaningful work for the good of every patient. People who are compassionate and serve with a purpose. People who aspire to excellence every day. People who are always ready to apply themselves.

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