Supervisor, UM Coordinator

About The Role
The UM Coordinator Supervisor manages the daily operations of the UM Coordinator team providing direct guidance and support with authorization creation, caller escalation and investigation of complex cases. The UM supervisor interacts with the clinical team to support the plan’s clinical operations. The Supervisor of the UM Coordinator reports to the UM Manager and/or Director of Clinical Programs.
Primary Responsibilities
• Supervises and supports the UM Coordinators’ daily activities.
• Provides mentoring and ongoing training of staff to enhance performance.
• Manages departmental UM Coordinator activity and ensures appropriate staffing levels and scheduling to meet department KPI’s (Key Performance Indicators).
• Collaborates with the clinical team and clinical leadership to address concerns and operational gaps in day- to-day activities.
• Supports and mentors the UM Coordinator team. Handles caller escalations and resolves as needed.
• Serves as subject matter expert (SME) for non-clinical authorization activities within the utilization management department.
• Conducts quality call monitoring audits and case file audits with clinical leadership to coach performance and identify additional training needs.
• Provides support to UM Coordinator team through regular monthly coaching sessions and team meetings.
• Manages special projects and allocates resources as needed.
• Collaborate with Network management team, Account Managers and Sales teams to gather feedback to enhance service performance.
• Participate in activities designed to improve member and client satisfaction and business performance.
• Works with UM Manager and/or Director to identify performance improvement initiatives and executes strategies accordingly.
• Support projects and other departments in completing tasks when directed by management.
Essential Qualifications
• HS diploma or GED.
• Team leadership experience required.
• Strong medical record review skills.
• Previous experience in quality monitoring, coaching, counseling, and progressive discipline strongly preferred.
• Prior experience in another healthcare plan or third-party payor environments strongly preferred.
• Ability to create staffing schedules and analyze workload volumes.
• Basic computer operations knowledge.
• Intermediate knowledge of Microsoft Office (Word, Excel, Access, PowerPoint, and Outlook.
• Strong time management skills.
• Previous knowledge of plan authorization activities and managed care procedures and workflows strongly preferred.
• Courteous with strong customer service orientation.
• Bachelor’s degree preferred (not required).
• Familiarity with medical terminology required.
 

About

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.

Come be a part of the Brightest Ideas in Healthcare™.

Company Mission

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

DEI Purpose Statement

At BHPS, we encourage all team members to bring your authentic selves to work with all of your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.

*We are an Equal Opportunity Employer