Utilization Management Supervisor - RN (Remote U.S.)

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company, to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra seeks a Utilization Management Supervisor (Remote U.S.) to join our growing team.

Job Summary:

As the Supervisor of Utilization Management, you will bring strong leadership to our utilization management activities, specifically catering to UMWA Funds beneficiaries. You will oversee a department responsible for pre-certifications, concurrent reviews, durable medical equipment authorizations, coordination, travel authorization, prepayment claims review, and appeals, ensuring our contract's efficient and effective utilization management.

Job Responsibilities:

• Supervise and coordinate all the activities related to the assigned programs.
• Ensure that the staffing levels, URAC requirements, and regulatory requirements are adhered to by monitoring the productivity and performance indicators of the clinical staff.
• Manage and complete assigned work plan objectives and projects within the given time frame.
• Provide advice and assistance to leaders in planning, implementing, and evaluating modifications to existing operations, systems, and procedures.
• Collaborate with the leadership team in developing new and improved products and services.
• Participate in committees, task forces, work groups, and multidisciplinary teams as a department representative.
• Maintain professional relationships with providers and external customers and identify opportunities for improvement.
• Develop and maintain policies and ensure compliance with regulatory and accrediting standards.
• Provide compliance and oversight reports and report contract-required Service Levels.
• Develop and improve auditor team members.
• Establish and maintain quality improvement plans (QIPs) by working closely with the quality manager.
• Manage and maintain the Action Code Database and Universe Reports.
• Maintain a positive relationship with clients by establishing ongoing communication and a collaborative approach to meeting their expectations.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

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EOE AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.

Required Qualifications/Experience:

• Bachelor's degree in nursing.
• An active, non-restricted Tennessee or compact license Registered Professional Nurse (RN) license.
• 5+ years of clinical experience.
• 3+ years of staff/workload management experience.
• Experience in Medicare.
• Experience in Utilization Management.
• Expertise in one or more of the following areas: emergency medicine, medical/surgical, behavioral health, pediatrics, or cardiology.
• Competence in Microsoft Office applications.
• Experience in utilization management, claims, appeals, and knowledge of criteria such as Milliman (MCG), InterQual, American Society of Addiction Medicine (ASAM), or similar.
• Proficiency in Medicare criteria for utilization management.
• Maintain a cheerful outlook.
• Contribute individually and as a team member to achieve the department's goals.
• Possess excellent medical record abstraction and quality management skills.
• Professionally respond to change while managing multiple and changing priorities with sometimes conflicting deadlines.
• Expertise in National Committee for Quality Assurance (NCQA)/Utilization Review Accreditation Commission (URAC) standards.
• Willing to become a subject matter and thought leader for the designated programs.

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The pay range for this position is $71,588 to 90,000 annually.

"Based on our compensation program, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."