Utilization Review Team Lead - RN at Memphis

Job Description

Utilization Review Team Lead

CLAIM YOUR FUTURE AS A GREAT PERFORMER!

Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwickhas a strong commitment to its colleagues and its clients. If you are seeking place where you can do great things for those whose livesyou touch while maximizingyour own career possibilities, Sedgwickis the place for you. As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as the Best TPA in America and the coveted Employer of Choice designation, we invite you to come be a part of our team and, Claim Your Future.

PRIMARY PURPOSE:To provide services for dedicated accounts; to ensure the efficient, cost effective, and high quality delivery of utilization review service by supervising and training a staff of registered nurses; to oversee the management of medical cases worked by registered nurses; to oversee individual and overall results/outcomes of all cases within their scope of responsibilities; and to ensure customer satisfaction through the provision of cost effective and high quality utilization review service that meets their needs.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Trains and develops utilization review staff.

Supervises a team of nurses ensuring utilization management services are delivered promptly, cost effectively, courteously, and according to legal requirements, operational, and quality assurance standards.

Takes corrective action when necessary ensuring objectives, standards, policies and procedures are met.

Works with program manager to establish and ensure achievement of office/unit customer service, utilization patterns, productivity, quality and financial goals.

Ensures that staff adheres to quality assurance and productivity standards: assists program manager in evaluating customer service utilization patterns, productivity, quality and financial results ensuring that service delivery is within parameters defined by the company.

Performs active customer service function for account; provides day-to-day contact with customer to resolve service delivery problems/issues; responds to customer requests; communicates any special customer instruction or procedure that must be adhered to by the registered nurse.

Advises staff of any pertinent changes in customer service delivery, regulatory mandates or business functions; provides training on regulatory issues.

Makes recommendation for ongoing and future service delivery options; identifies referrals for case management.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.

Supports the organizations quality program(s).

SUPERVISORY RESPONSIBILITIES

Administers company personnel policies in all areas and follows company staffing standards and training recommendations.

Interviews, hires and establishes colleague performance development plans; conducts colleague performance reviews.

Provides support, guidance, leadership and motivation to promote maximum performance.

QUALIFICATIONS

Education & Licensing
Baccalaureate degree from an accredited college or university preferred.RN license required. CPUR or other related designation required.

Experience
Five (5) years of clinical practice experience including two (2) years supervisory experience required.

Skills & Knowledge

• Strong knowledge of utilization review practices
• Expert knowledge of the insurance industry and claims processing
• Acquired knowledge of GM claims process, plan design and customer needs
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Leadership/management/motivational skills
• Analytical and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental:Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical:Computer keyboarding, travel as required

Auditory/Visual:Hearing, vision and talking

NOTE:Credit security clearance, confirmed via a background credit check, is required for this position.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances.Management retains the discretion to add or to change the duties of the position at any time.

Sedgwickis an Equal Opportunity Employer

and a

Drug-Free Workplace

Job Requirements

N/A


Country: USA, State: Tennessee, City: Memphis, Company: Sedgwick CMS.