Utilization Review Supervisor

UTILIZATION REVIEW SUPERVISOR

Rockford Remote

In this position you will be working with a team of independent and autonomous Intake Coordinators and Utilization Review Nurses to break down barriers and ensure quality and timely determinations are delivered to providers and collaboration with your department manager and the Leadership Team you will strive for continuous improvement and an excellent work-life balance to produce top-notch

results.

WHAT YOULL BE DOING

• Coordinating and providing care management and care that is timely effective efficient equitable safe and member centered.
• Managing case assignments (outreach documentation case progression and case closures) meeting reporting and documentation standards and engaging in collaborative meetings with clients.
• Monthly attendance and coordination of UM/PHM Committee Meetings including material preparation minutes data collection and analysis reporting and follow-up tasks.
• Training new and current employees with Preceptors.
• Re-education for audit fallouts.
• Assisting in creating re-evaluating and updating workflows/processes.
• Updating internal knowledge base and Confluence pages.
• Assisting in creation re-evaluation and analysis of necessary reporting and identification of reporting opportunities.
• Attending and participating in virtual and in-person leadership meetings as necessary.
• Responsible for continued professional growth and education that reflects knowledge and understanding of current nursing care practice as outlined in the Illinois Nurse Practice Act.
• Other responsibilities as assigned including assisting with payroll and monitoring FTO requests as well as completing coaching and performance reviews with the team.

• Communication with IPA Administrators and Client Business Managers to ensure resolution of any concerns.

Qualifications :

Qualifications

WHAT YOULL NEED FOR SUCESS

• Current Registered Nurse License (State of Illinois requires Nursing Professional Staff to complete 20 hours of CE per 2-year license renewal cycle).
• Minimum of 3 years of experience Case Management Managed Care Health Insurance.
• Knowledge of utilization review quality improvement managed care and/or community health.
• Excellent knowledge of case management principles healthcare management and reimbursement components with experience in motivational interviewing
• Excellent clinical judgment as well as highly skilled in verbal and written communication.
• Strong organizational problem solving and time management skills.
• Ability to ensure timely completion of projects and assignments.
• Ability to prioritize and react based on rapidly changing business needs.
• Must have ability to work independently and remotely with multi-tasking skills for fast paced workflows.
• Must possess excellent software knowledge including word processing and spreadsheets computer skills including MS Word Excel Access PDF Outlook etc.
• Experience navigating multiple EMRs.
• A high speed/secured home internet connection a home office with a door that locks for security and privacy purposes and back-up connection service options for internet outages

Additional Information :

ALIVE with Purpose: How We Thrive at Guidehealth

At Guidehealth our values come to life in everything we do.

• We are Driven by Accountability grounded in transparency reliability and integrity as we navigate challenges and opportunities alike.
• Always Growing Always Learning staying curious and continuously improving inspires us to shape a better future for healthcare.
• With Collaborative Innovation we solve problems creatively making every experience better for our employees and the patients we serve.
• At Guidehealth Every Voice Matters we believe our collective strength is rooted in the unique perspectives of each team member.
• And through Empathy in Action we build stronger connections with those who count on us.
• This is what it means to be ALIVE with purpose. This is how we thrive together at Guidehealth.

BENEFITS:

While you are hard at work advancing value-based healthcare we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical Dental and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those just in case moments. Additionally we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include but are not limited to: skill set years of relevant experience education location and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT

Diversity inclusion and belonging are at the core of Guidehealths values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race religious creed color age sex sexual orientation and identity national origin citizenship religion marital status familial status physical sensory or medical disability Family and Medical Leave military or veteran status pregnancy childbirth or other related medical conditions or any other classification protected by federal state and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring placement promotion transfer demotion layoff termination recruitment advertising pay and other forms of compensation training and general treatment during employment.

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealths custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles the responsibilities would be further defined by the hiring manager.

As a remote-first organization handling sensitive healthcare data Guidehealth verifies candidate identity at multiple stages of the hiring and onboarding to safeguard patient privacy data security and compliance requirements.

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 100 mbps download 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements.

Remote Work :

Yes

Employment Type :

Full-time

Key Skills
Restaurant Experience,Customer Service,Hospitality Experience,Management Experience,Mediation Experience,Guest Services,Merchandising,Experience with Children,Leadership Experience,Mentoring,Supervising Experience,Neonatal Ventilator
Experience: years
Vacancy: 1