The Non-Clinical Supervisor, Utilization Management leads a team of utilization management case aides and intake coordinators that are responsible for supporting Bright’s utilization management function. The team will assist in the monitoring and coordination of authorization and appeal cases. Necessary actions may include data entry, case escalation, notification of determinations and care management referrals. The Supervisor position will provide guidance, training, and oversight to a group of Case Aides and intake coordinators as well as fielding Case Aide and intake coordinators inquiries directly. This individual will serve as a role model for team members, assuring both members and providers have a positive experience with the services they receive. The Non-Clinical Supervisor, Utilization Management ensures all related initiatives meet all applicable state and/or federal regulatory requirements in addition to corresponding URAC standards.

ROLE RESPONSIBILITIES

• Provide leadership and direction to a team of Utilization Management Case Aids and intake coordinators, inclusive of training and performance oversight.
• Support staffing and scheduling plans to meet departmental objectives as provided by leadership, including meeting specified service levels.
• Monitor operational key performance indicators to track service delivery against targets. Audit staff members to ensure compliance.
• Recruit, hire and train new team members.
• Enforce UM policies and procedures to ensure compliance with state and federal agencies as well as accreditation standards.
• Support the development and maintenance of standard operating procedures related to corresponding program functions.
• Participate in the development of operating models to execute utilization management solutions.
• Assist in the preparation with all applicable audits pertaining to utilization management.

SUPERVISORY RESPONSIBILITIES

This position has supervisory responsibilities for members of the Utilization Management team.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• High School Diploma or GED required; Bachelor’s Degree in a related field preferred
• Three (3) or more years of supervisory experience within a consumer support function
• Two (2) or more years of healthcare related experience
• Awareness and experience with HIPAA requirements for healthcare communication
• Prior experience with URAC accreditation is desired, but not required
• Formal training in Six Sigma management techniques is desired, but not required

PROFESSIONAL COMPETENCIES

• Approaches challenges calmly and objectively to identify the best solution
• Capable communicator that can interact with others at multiple levels within the organization, customers and providers
• Leads through influence and example
• Strong operational mindset and uses data to draw insights
• Thrives on driving results in a collaborative environment

WORK ENVIRONMENT

The majority of work responsibilities are performed in a home office or open office environment, carrying out responsibilities sitting/standing at a desk/table and working on the computer. Travel is not required.

For individuals assigned to a location(s) in California, Bright Health is required by law to include a reasonable estimate of the compensation range for this position. Actual compensation will vary based on the applicant’s education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the range is $54,845.35-$82,268.03 annually.

Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; paid time off, and paid holidays.