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Weekend Supervisor Utilization Management Jobs in California

Acadia Healthcare

Director of Utilization

San Rafael, CA · On-site

$105K - $130K/yr

Four or more years' experience in utilization management required. * Three or more years of supervisory experience required. LICENSES/DESIGNATIONS/CERTIFICATIONS: * If applicable, current licensure ...

PACS

RN Weekend Supervisor-Saturday-Sunday

Clovis, CA · On-site

$42 - $45/hr

Perform utilization review activities to ensure appropriate, timely, and cost-effective care ... Demonstrate excellent time management skills in a fast-paced, high-volume environment. * Maintain ...

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Weekend Supervisor Utilization Management information

What does a weekend supervisor in utilization management do?

A Weekend Supervisor in Utilization Management oversees the review and coordination of patient care services during weekends to ensure appropriate use of healthcare resources. They manage a team of utilization review staff, ensure compliance with policies, and facilitate communication between healthcare providers and insurance companies. Their role is critical in making timely decisions about patient admissions, continued stays, and discharges, focusing on quality care and cost efficiency. They also handle escalations and provide support to staff working outside of regular business hours.

What are the primary challenges a weekend supervisor in utilization management faces, and how can they be addressed?

Weekend Supervisors in Utilization Management often encounter challenges such as limited staff availability, high patient volume, and the need for rapid decision-making with less direct access to physicians or ancillary services. To address these, strong organizational skills, proactive communication, and the ability to prioritize urgent cases are essential. Supervisors should foster a collaborative atmosphere, leverage digital tools for efficient workflow, and ensure clear escalation protocols for complex cases, all while maintaining regulatory compliance and quality patient care.

What are the key skills and qualifications needed to thrive as a weekend supervisor in utilization management, and why are they important?

To thrive as a Weekend Supervisor Utilization Management, you need a comprehensive understanding of clinical guidelines, utilization review processes, and healthcare regulations, typically supported by a nursing degree (RN) or related clinical licensure. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of relevant accreditation standards (such as URAC or NCQA) are essential. Strong leadership, decision-making, and effective communication skills help navigate team dynamics and complex case reviews during weekend shifts. These skills ensure efficient resource management, compliance with healthcare standards, and consistent quality of care even outside regular business hours.

What is the difference between Weekend Supervisor Utilization Management vs Weekend Utilization Review Coordinator?

AspectWeekend Supervisor Utilization ManagementWeekend Utilization Review Coordinator
CredentialsTypically requires a healthcare-related license or certification (e.g., RN, LPN, or case management certification)Often requires similar healthcare credentials, such as RN or case management certification
Work EnvironmentSupervises utilization management staff, oversees case reviews, and ensures compliance during weekendsPerforms case reviews, evaluates medical necessity, and coordinates utilization decisions during weekends
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance providers, healthcare organizations

The main difference is that the Weekend Supervisor Utilization Management role involves supervising staff and managing utilization processes, while the Weekend Utilization Review Coordinator focuses on conducting case reviews and making utilization decisions during weekends. Both roles require healthcare credentials and operate within similar environments, but their responsibilities differ in scope and leadership level.

What are the most commonly searched types of Supervisor Utilization Management jobs in California?

The most popular types of Supervisor Utilization Management jobs in California are:

What are popular job titles related to Weekend Supervisor Utilization Management jobs in California?

For Weekend Supervisor Utilization Management jobs in California, the most frequently searched job titles are:

What job categories do people searching Weekend Supervisor Utilization Management jobs in California look for?

The top searched job categories for Weekend Supervisor Utilization Management jobs in California are:

What cities in California are hiring for Weekend Supervisor Utilization Management jobs?

Cities in California with the most Weekend Supervisor Utilization Management job openings:

Weekend Supervisor Utilization Management jobs near you

UTILIZATION MANAGEMENT COORDINATOR I MSO

Burlingame, CA • On-site

NORTH EAST MEDICAL SERVICES
Health Care and Social Assistance • 51 - 200 employees
Learn more about NORTH EAST MEDICAL SERVICESexternal

$38/hr

Full-time

Medical, Dental, Vision, Retirement

Re-posted 29 days ago

Job description

The Utilization Management Coordinator I functions under the direct supervision of a physician or Registered Nurse, performing utilization management (UM) and care coordination duties for the NEMS MSO.

ESSENTIAL JOB FUNCTIONS:

  • Review daily all incoming Referral Requests and Treatment Authorization Requests for inpatient and outpatient services.
  • Process and approve authorization requests according to the NEMS MSO Authorization Grid and to established clinical guidelines.
  • Must meet the quantitative productivity standard of 250 authorizations per week for the outpatient UM Coordinator and 115 authorizations per week for the inpatient UM Coordinator.
  • For complex cases, research additional relevant clinical guidelines from different sources.
  • Responsible to prepare and present complex cases to Medical Director for review; confirm Medical Director's approval/modification/denial decision for record tracking.
  • Perform Care Coordination activities with members, families, specialists, and ancillary providers for authorized services.
  • Perform customer service for UM inquiries to Primary Care Physician, specialist, and members.
  • Stay current with DHCS regulations, Health Plan agreements, and Industry Standard guidelines applicable to healthcare programs.
  • Communicate UM related information and updates to all members of the health care team, patients, and their families.
  • Follow the appropriate turnaround timeframe for decisions and notification of members and providers.
  • Performs other job duties as required by manager/supervisor.
  • Completion of a 2-year degree or higher.
  • Knowledge of medical terminology.
  • Completion of a recognized Medical Assistant degree or certificate a plus.
  • Excellent data entry skills.
  • Working knowledge of managed-care a plus.
  • Strong communication, analytical, and problem-solving skills.
  • Knowledge of community resources and cultural needs.
  • Good organization and prioritization skills, outstanding in time management.
  • Recent experience in a clinic or outpatient setting desirable; able to perform efficiently and appropriately in a busy environment.

LANGUAGE:

  • Must be able to fluently speak, read and write English.
  • Fluent in Chinese (Cantonese and/or Mandarin) preferred.
  • Fluent in other languages is an asset.

STATUS:

  • This is an FLSA Non-exempt position.
  • This is not an OSHA high-risk position.
  • This is a Full Time position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).
 

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