Supervisor Utilization Management

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Supervisor Utilization Management Work from home within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia’s dedicated team of clinical leaders are living our mission to make health care easier and lives better. As a member of the Utilization Management Inpatient leadership team, our Supervisor Utilization Management supervises the team and acts as a resource for utilization management professional and support staff. Oversees and coordinates team activities to achieve business objectives and ensure medically necessary, cost-effective, quality care is delivered to members through various utilization management programs, including prior authorization and inpatient concurrent review, and regulatory compliance. May also be responsible for ensuring that medical payments are appropriate and in alignment with contract provisions, proper coding and policy compliance – all in service of making our members’ health journeys easier. As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us. Are you passionate about improving healthcare journeys? Do you find yourself naturally guiding your colleagues and thinking about how processes could work better for our members? Then this role may be the perfect fit.

Assigns and prioritizes work, sets goals, and coordinates daily activities of the team. Provides regular updates and communication to staff through 1:1 and team meetings. Monitors individual and team results to ensure work is completed in a timely manner, in accordance with department standards and procedures, and is in compliance with medical policy and medical necessity guidelines. Assists in development of productivity and quality standards. May conduct or participate in compliance audits and report audit findings. Identifies and implements process improvements as needed. Acts as a resource for staff and others. Appropriately escalates issues and partners with other departments to resolve issues and remove barriers. Collaborates with physician advisors on complex case and coverage determination processes. Participates in the hiring process, provides on-going coaching, employee development and writing of performance reviews. Develops and maintains desk reference guides on work procedures. Ensures new hires complete necessary training. Assesses training needs and plays an active role in development of staff. Completes special projects as assigned and may provide back-up support to staff as needed. Maintains clinical competency and keeps current on medical practices, procedures and industry trends. May develop and present educational updates to other departments. May develop and present educational updates internally or to other departments. Seeks ideas and opportunities for continuous improvement, determines which opportunities should be pursued and implements improvements as appropriate.