Fort Lauderdale, FL
- Job Level:
We are currently seeking a Utilization Management Supervisor who will be responsible for assuring that all clients’ patients and providers’ needs are met by receiving phone calls from both members and phone calls and faxed referrals from providers. Activities implemented are to facilitate the authorization and coordination of referrals utilizing pre-approved screening criteria in compliance with contracted Client's requirements.
- Assures that UM authorization coordinators are available to receive phone calls and faxed referral requests from providers.
- Assists UM authorization coordinators with phone calls and referral requests as necessary.
- Is resource person for all coordinators for all clients’ utilization management activities.
- Monitors incoming faxes and distributes work among the authorization coordinators.
- Is liaison between providers and UM authorization department, trouble shoots any problems arising in UM Authorization process and reports to supervisor as well as to appropriate departments.
- Assists with compiling monthly utilization management statistics.
- Reviews monthly phone statistics and phone criteria with Director of Utilization and comes up with corrective action plan as necessary.
- Assists with quarterly inter-rater reliability reports of non-clinical UM staff.
- Assures that authorization coordinators are in-serviced on all various clients’ products.
- Ensures that departmental and organization goals are met.
- Ensures that Coordinator meet productivity requirements.
- Identify and facilitates training needs on Coordinators.
- Ensures that all requests are timely processed.
- Ensures that Coordinators maintain a professional and productive behavior.
- Ensures that daily reports are timely monitored.
- Makes sure all authorization coordinators are instructed and well versed in their duties
- High school diploma or general education degree (GED)
Experience & Skills Required
- Supervisory and Utilization Management experience, preferably in a managed care setting, for at least a year.
- Solid knowledge of medical terminology, CPT & ICD-10 Coding, Medicare and Medicaid requirements.