Supervisor, Utilization Management

Imagine360 understands We developed a self-funded health plan solution that’s fixing today’s one-size-fits-none PPO insurance problems with powerful, customized solutions. We take a different approach: putting control back in your hands and providing access to higher-quality care. For you, your employees and their families. With deep savings. And unwavering support. Imagine that.

Imagine360 is seeking a Supervisor, Utilization Management to join the team! The Supervisor, Utilization Management is responsible for utilizing their nursing education, clinical, and professional experiences to provide supervision to the Utilization Management Nurses and associated programs and processes, as directed by the Senior Manager, Patient Review and Intake Services. Position Location: 100% remote

Collaborate with Senior Manager, Patient Review & Intake Services or Manager, Utilization Management to: Manage team responsible for completing utilization management programs, processes, and tasks. Edit, maintain, and implement policies & procedures that meet applicable regulatory, accreditation, and business needs. Implement orientation curriculum and ongoing training and educational needs. Coordinate and supervise daily employee activities through supervision of the UM team. Maintain daily case assignment statistics and reporting for metrics. Manage and coordinate daily & weekly staffing needs and schedules based on the business. Review and manage approvals and communications for PTO requests by employees, as directed by the Manager or Senior Manager. Conduct performance evaluations and performance improvement plans for team. Conduct monthly 1:1 coaching sessions with UM Nurses, BR Nurses, and Lead Nurses. Lead bi-monthly UM Nurse and Benefit Review Nurse meetings. Lead the interviewing and hiring processes as needed. Research member complaints and issue resolutions. Lead projects and employee discussions that promote improvement in the delivery of services within the department. Collaborate with Quality Management programs by assisting in the quality assurance review and chart audit processes for UM employees. Perform monthly call and chart audits for the UM Nurses, BR Nurses, and Lead Nurses. Review QA results to develop educational opportunities for the UM employees and completes performance improvement plans for scores <90% per policies and procedures. Review policies and procedures as required and recommends changes to the Manager and Senior Manager. Collect, analyze, and report data of quality improvement projects and other data related to utilization services and benefit review services. Assist Supervisor, MIS with triaging of cases and monitoring call que as needed. Escalate high priority, high risk cases or staffing issues appropriately to Manager or Senior Manager. Perform UM tasks as staffing levels dictate. Communicate effectively with members, employees, healthcare providers, vendors, peers, and customers. Act as role model within a team setting to provide mentoring, coaching, and positive outcomes for employees, peers, and overall operations. Attend team and department meetings, trainings, and other job specific events as required. Adhere to established internal regulations regarding Department of Labor, HIPAA, ERISA and department and company policies and procedures. Complete HIPAA training and trainings assigned by quality team monthly/annually; follow PHI guidelines. Complete duties in accordance with scope of licensure and certifications held or requested. Other duties as assigned by the Manager or Senior Manager.