Utilization Review Supervisor (RN)
Location: Pearland Administrative Office
Department: Utilization Management
Job Type: Full-Time
Kelsey-Seybold Clinic. Your Doctors for Life.
Since 1949, Kelsey-Seybold Clinic has served its patients with one goal in mind – combine the expertise of physicians in a variety of medical specialties, with the close personal care of a family doctor. Kelsey-Seybold is Houston’s largest community-based physician group, caring for more than 400,000 patients. With 19 clinic locations, we are growing to meet the health care needs of our diverse patient population. Our mission is to provide our team members with exceptional opportunities for professional and personal growth.
The UR Supervisor supervises and directs the pre-certification process and staff assigned to work groups to ensure compliance with the delegated utilization management responsibilities and utilization review license. The Supervisor is responsible for the daily operations of the UR Department and works with the Manager of Utilization Review/Health Services to develop and refine processes and meet reporting requirements. The UR Supervisor is a facilitator of communication with clinic, payers, medical director and other customers. Responsible for identifying areas of improvement for staffing results. Make recommendation based on quality deficiencies identified. Providing daily oversight of UM Nurses, Responsibilities include providing clinical, technical and operational support and direction, including organization and monitoring of pending referral /authorization requests. Responsible for direct supervisory oversight of professional and front line staff receiving requests for authorizations from providers and members.
EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS
(A = basics; B = preferred)
Registered Nurse, CEU requirements
5 years varied medical/surgical experience.
3 years UR or case management experience.
Computer and Coding experience.
2 years previous supervisory or management experience
TX RN license, valid driver's license
3 years of Kelsey Seybold Clinical Operations experience.
Good organizational and communication skills.
HMO, PPO and POS Insurance knowledge.