This position is 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. UM Supervisor has to be a competent, knowledgeable resource for information. Under the direction of the Utilization Management Director, supervises the Coordinators and provides them with leadership to ensure high quality results.
This job has supervisory responsibilities as well as teaching responsibilities to assure quality performance of UM authorization staff.
High school diploma or general education degree (GED); 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.