22 days old

Registered Nurse RN Supervisor UMCM Healthcare WellMed San Antonio TX

San Antonio, TX 78205
  • Job Code

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm) 


The Supervisor of Utilization Management Services is responsible for the supervision, evaluation and direction of the Utilization Compliance and Quality Management process. The position will ensure compliance with the utilization management program for all pre service requests and empowers team members through active problem solving and resource direction. The position is a resource for difficult or complex and/or exceptional preauthorization requests. The supervisor successfully impacts assigned team and organization by mentoring those who wish advancement and engages in departmental process improvement teams and activities. In addition, the Utilization Management Supervisor is responsible for timely completion of documentation audits, and reviewing and mentoring team members to meet and exceed all documentation compliance standards. This position mentors and trains staff in the completion of timely, accurate um determinations and functions as an advisor to Physicians and lower level utilization management staff.


Primary Responsibilities:

  • Assist in development of training materials; acts as Subject Matter Expert
  • Fields questions and serves as a resource for Clinicians and non-clinicians Assists with reviews and updates job aids to maximize quality and productivity
  • Trend, analyze and improve processes and suggests improvements
  • Supports utilization management operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating)
  • Oversees utilization management functions and ensure compliance with application of criteria from approved standardized guidelines, government mandated regulations and contractual agreements
  • Plans, organizes and oversees staff to ensure timely completion of um determinations
  • Ensures team meets established performance metrics and medical cost reduction goals. Includes timely reporting of monthly metric reports
  • Adapts and collaborates with management on departmental plans and priorities to address business and operational challenges
  • Oversees the team's daily staffing requirements to meet program standards
  • Implements and interprets organizational policies and procedures, reviews work of staff to ensure that policies and guidelines are appropriately applied
  • Analyze, communicate results/trends, and collaborate with leaders to develop action plans for key reports: TAT Report, Quality audits and any other additional team specific reports
  • Tracks and trends outcomes for potential improvements in the utilization management process
  • Interviews, hires, and retains staff in collaboration with management to meet the needs of the department
  • Evaluates staff performance and conducts merit increases, and disciplinary actions on staff as needed
  • Conducts annual evaluations of team members in a timely basis; provides feedback in a constructive manner and respects the confidentiality of personnel issues
  • Monitors and oversees the reporting of all quality issues to medical management leadership for referral and reporting to health plans as appropriate
  • Monitors appropriate utilization of resources, overtime, and supplies
  • Reviews difficult and/or exceptional preauthorization requests while assisting with any escalated issues from providers
  • Performs all other related duties as assigned

This is an office based position located at our office off of Northwest Parkway in San Antonio, TX. The position requires a rotating Saturday shift.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.



Posted: 2020-09-08 Expires: 2020-10-08

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Registered Nurse RN Supervisor UMCM Healthcare WellMed San Antonio TX

UnitedHealth Group
San Antonio, TX 78205

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