Supervisor, Utilization Management at VillageMD
Join VillageMD as a Supervisor, Utilization Management in Atlanta, GA
Join the frontlines of today's healthcare transformation
At VillageMD, we're looking for a Supervisor, Utilization Management to help us transform the way primary care is delivered and how patients are served. As a national leader on the forefront of healthcare, we've partnered with many of today's best primary care physicians. We're equipping them with the latest digital tools. Empowering them with proven strategies and support. Inspiring them with better practices and consistent results.
We're creating care that's more accessible. Effective. Efficient. With solutions that are value-based, physician-driven and patient-centered. To accomplish this, we're looking for individuals who share our sense of excellence, are ready to embrace change, and never settle for the status quo. Individuals who have the confidence to lead but the humility to never stop learning.
As the Supervisor, Utilization Management, 50% of your time will be spent managing a team of RN/LPNs and 50% of your time will be spent managing a modified patient panel of high-risk patients.
How you can make a difference
Utilization Management Coordinator Job Responsibilities (50%)
- Meet with patients who have chronic conditions and/or a history of avoidable utilization at the bedside after admission to the hospital or Skilled Nursing Facility
- Provide patient advocacy, education, self-management teaching and assist in mitigating barriers to discharge
- Coordinate follow-up appointments for patients with appropriate physician(s) and other health care providers
- Coordinate with hospital physicians/staff ensuring patients are placed in the appropriate level of care (inpt/obs)
- Provide patient updates and clinical interventions provided for internal rounding and IDT meetings
- Establish an open and clinical-based rapport with local home health and skilled nursing facilities for post-acute patients
- Coordinate with interdisciplinary team members to meet patients physical and psychosocial needs
Supervisory Job Responsibilities (50%)
- Manage each team member of the Utilization Management team through frequent communication, case reviews, performance evaluations, onsite assistance, and as a resource as needs arise
- Lead orientation and training for new Utilization Management staff related to managing role/workflow expectations
- Perform case reviews of Utilization Management peers evaluating policy/protocol adherence, interdisciplinary team collaboration, and utilization trends of engaged populations
- Provide peer to peer feedback related to productivity and caseload management opportunities
- Work collaboratively with market leadership to develop and refine workflows and processes representing clinical best practices
- Represent Utilization Management on established case review meetings for utilization management
- Host team meetings for complex case reviews, workflow review and team building purposes
- Meet with practice leadership, as requested, representing CM roles, functions, and opportunities to drive improved patient care.
- Ensure educational compliance of Utilization Management team members via LMS and annual compliance trainings
- Monitor metrics and provide data (qualitative and quantitative) as request by supervising director.
- Other abilities or task as defined by the supervising director
Skills for success
- A collaborative communication style and the ability to coordinate interdepartmentally
- Strengths based management style and the ability to give constructive feedback
- Passion for data driven quality patient care
- The ability to be flexible in an ambiguous and dynamic environment
- A service orientation and a “can do” attitude
- A willingness to learn on your own and take initiative
- A low ego and humility; an ability to gain trust through good communication and doing what you say you will do
- Cohesive work with other clinical and administrative teams
Experience to drive change
- 3+ years of direct, clinical nursing experience
- RN with previous experience in discharge planning or post-acute care preferred
- Comfort with technology including Microsoft suite of products
- Knowledge of InterQual, Milliman, and/or Experian Health Criteria
- Knowledge of Commercial Medicare and Medicare Advantage insurance
- Utilizing a variety of electronic health records including data capture, data mining and reporting
- Comfort and experience in data driven program design
How you will thrive
In addition to competitive salaries, a 401k program with company match, bonus and a valuable health benefits package, VillageMD offers paid parental leave, pre-tax savings on commuter expenses, and generous paid time off. You work in a highly-collaborative, conscientious, forward-thinking environment that welcomes your experience and enables you to make a significant impact from Day 1.
Most importantly, you make a difference. You see a clear connection between your daily work on VillageMD products and services and the advancement of innovative solutions and improved quality of healthcare for providers and patients.
Our unique VillageMD culture – how inclusion and diversity make the difference
At VillageMD, we see diversity and inclusion as a source of strength in transforming healthcare. We believe building trust and innovation are best achieved through diverse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the same way, including our healthcare system. Individuals seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
Those seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.
Explore your future with VillageMD today.