Kelsey-Seybold

  • Utilization Review Supervisor (RN)

    Location US-TX-Pearland
    Posted Date 2 months ago(4/23/2018 12:08 AM)
    Job ID
    2018-18784
    Category
    Nursing
  • Overview

    Utilization Review Supervisor (RN)

    Location: Pearland Administrative Office

    Department: Utilization Management

    Job Type: Full-Time

     

    COMPANY PROFILE

    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.​​

     

    JOB SUMMARY

    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)

    Education

    A.

    Registered Nurse, CEU requirements

     

    B.

    BSN 

    Experience

    A.

    5 years varied medical/surgical experience.

    3 years UR or case management experience.

    Computer and Coding experience.

     

    B.

    2 years previous supervisory or management experience

     

    Licenses

    A.

    TX RN license, valid driver's license

     

    B.

    3 years of Kelsey Seybold Clinical Operations experience. 

    Special Skills

    A.

    Good organizational and communication skills.

     

    B.

     

     

     

    Other

    A.

    HMO, PPO and POS Insurance knowledge.

    B.

     

     

    WORKING ENVIRONMENT

    Clinical

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