Utilization Management Nurse Jobs in Minnesota (NOW HIRING)

HealthPartners is hiring a Supervisor, Utilization Management. This position provides supervision to, and performance management of, the utilization management staff. Provide leadership in process management, provide technical support with excellent computer skills and provide personnel management. Direct and coordinate collection, processing and entry of data into the medical management system to ensure accurate and reliable authorization and admission notification records. Direct and coordinate the processing of letters and other functions needed to meet regulatory and accreditation standards. 

ACCOUNTABILITIES: 

Process Management:

• Coordinates and directs the workflow processes of utilization management staff to ensure that customer needs and compliance requirements are met.
• Maintains an understanding of state and federal regulations, accreditation standards, HealthPartners products and networks, member contracts and Health Plan policies and procedures related to Utilization Review, Inpatient Admissions and Long Term Care Admissions and Tracking in order to promote consistency and ensure compliance.
• Maintains a working knowledge of Medical Policy, Behavioral Health (Health Plan) and Inpatient Case Management Processes and workflows. 
• Evaluates current processes and systems workflow to identify inefficiencies, needs and opportunities for improvement. Recommends and implements changes to ensure quality, compliance and efficiency of processes. 
• Assists with data analysis and interpretation in order to identify and address data quality issues when they arise. Suggests alternate reporting strategies as appropriate.
• Initiates development and utilization of daily operational reports to monitor staff productivity and compliance with processes.
• Works with Manager to ensure implementation of new processes and initiatives in a timely and effective manner.
• Participates in and/or effectively leads various committees, workgroups, and projects as needed and assigned.

Customer Service:

• Ensures all staff, processes and programs are customer-focused, resulting in high levels of customer, member/patient/family, colleague and team member satisfaction.
• Serve as point of contact and coordinator of issues related to Admissions Unit and/or Medical Policy Support Tech units. This includes interaction with many internal departments including Medical Policy, BH, Case Management, Claims, Government Programs and Member Services, as well as external customers including hospital admissions units, nursing home staff, HPMG staff, medical records and business offices.

Relationship and Team Building:

• Establishes and maintains good working relationships within QUI department, with other HealthPartners departments, and with external customers to facilitate excellence in processes and outcomes.
• Creates and maintains a cohesive team by facilitating a collaborative, respectful, diverse environment.

Staff Supervision, Development and Evaluation:

• Responsible for the supervision of staff, including having the authority to hire, transfer, lay off, promote, discipline and discharge, train, reward and review performance of employees. Ensures compliance to organizational and departmental policies and procedures.
• Builds effective relationships and inspires staff to achieve excellence in the daily operations.
• Embraces change. Creates an environment that encourages creativity, independence, and willingness to change.
• Monitors staffing and recommends adjustments to Manager as needed.
• Promotes staff development in assignment of special projects, ongoing independent study, and education-related activities, to maintain and increase knowledge in the areas of responsibility.

Communication:

• Communicates with Medical Policy teams, Behavioral Health department, Inpatient Case Management Supervisors and Managers, Systems Support Team and individual staff members to facilitate successful daily operations.
• Maintains confidentiality of information in accordance with department and corporate policies.
• Assists in development of policies and procedures to meet health plan, departmental, regulatory and accreditation requirements.
• Provides routine updates on team status, including productivity, issues and outcomes to Managers. 
• Collaborates with, and acts as a resource to, internal and external customers on HealthPartners inpatient hospital records, long-term care records, Medical Policy Support tech processes and related applications. 

Technology:

• Maintains knowledge of and effectively uses automated applications and systems.
• Implements strategies to ensure efficiency and productivity through proficient use of automated system.
• Review and edit documentation related to new programs and software for medical management, including on-line help files. 
• Develop and maintain effective manuals and systems tools to be used for orientation, training and as ongoing resources. 
• Serve as a Super User for select medical management applications. This includes participation in system design, system testing, system training, identifying and requesting system enhancements and day to day troubleshooting.
• Work with MMSG team and other IS&T teams, as needed, to assist with SRF submission, testing and sign-off.

Personal Development:

• Participates in ongoing independent study, education-related professional activities, and professional affiliations to maintain and increase knowledge in the areas of Utilization review and Inpatient Notifications.
• Participate in ongoing independent study and education to develop and maintain knowledge in the areas of applicable software systems, regulatory and accreditation standards.
• Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for personal growth and development.
• Consistently applies HealthPartners organizational and department values (missions/ vision / initiatives), values and continuous quality improvement principles in relationships, daily work, and program supervision.
• Participate in the creation and updating of Business Continuity and Disaster Recovery plans

Other Duties:

• Participates in various committees, task forces, projects, and quality improvement teams, as needed and assigned.
• Performs other duties as assigned.

Current Dimension. (May change over time)

• Reports to Manager, Utilization Management.
• Directly supervises staff as assigned.
• Interacts with medical, administrative, and front-line staff within and outside the organization.
• Supervises daily operations of processes serving HealthPartners members.

REQUIRED QUALIFICATIONS: 

• Associate degree in healthcare, business or related field.
• Five years experience in health care, quality improvement, utilization review, or related experience. 
• Effective leadership and supervisory skills.
• Demonstrated experience with development and documentation of workflows and processes.
• Demonstrated competency with PC Hardware and Software including MS Word and Excel
• High level of expertise in written, oral, and interpersonal communication.
• Demonstrated skill in effective use and management of medical management systems and software.
• Demonstrated ability to function independently and cooperatively.
• Ability to plan, organize and prioritize work effectively, including the flexibility to accommodate frequent changes.
• Understanding of healthcare and/or HMO industry.
• Demonstrated experience in hiring, orientation, coaching, and team building.
• Demonstrated flexibility and organizational skills.
• Demonstrated appropriate decision making under challenging situations.

PREFERRED QUALIFICATIONS:

• Bachelor's degree in healthcare, business or related field.
• Two years experience supervising staff.

CHALLENGES:

• Maintaining focus on the desired mission and vision while effectively responding to a rapidly evolving environment.
• Influencing team members and colleagues to work collaboratively in achieving the goals and objectives of the Admissions Unit and Medical Policy teams.
• Optimization of interdependent, cross-divisional processes and strategies for successful change, with compliance to regulatory, accreditation, and customer requirements.
• Dual reporting structure.
• Supervising staff during significant change and rapid implementation.

DECISION-MAKING: 

• Provide direct supervision and organizational coordination to support 8-20 union employees 
• Make independent decisions within the scope of this position's accountabilities and determine the need for and the timing of consultation with leadership.
• Use professional judgment, organizational knowledge, industry knowledge, and common sense in determining appropriate workflows and processes, consulting with leadership, when indicated.
• Solutions to problems or projects involving other departments are presented to the manager prior to implementation
• Make recommendations to leadership regarding policy development and/or changes.