Presbyterian Healthcare Services

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SUPERVISOR-HEALTH SERVICES-UTILIZATION REVIEW

at Presbyterian Healthcare Services

Posted: 9/3/2020
Job Reference #: 13381
Keywords: healthcare, health

Job Description

Requisition ID
2020-13381
Category
Case/Utilization Mgmt/Care Coor
Default: Location : City
Albuquerque
Location : Name
Rev Hugh Cooper Admin Center
Default: Location : State/Province (Full Name)
New Mexico

Overview

Job Description
Type of Opportunity: Full Time
FTE: 1.000000
Exempt: Yes
Work Schedule: Weekday Schedule Monday-Friday

Summary:
Performs administrative leadership role in the training, coordination, and supervision of daily operational activities to ensure that departmental tasks are assigned and carried out. Oversight of teams includes developing & maintaining models for tracking of staff performance. Assists the Manager and Director to apply performance measurements and/or ensure that the level of care and services requested meet quality of care standards. Conducts direct departmental duties as needed.

Responsibilities

Responsibilities:
*Supervises daily workflow functions related to applicable departmental activities, including but not limited to the identification and screening for appropriateness of request for services

*Monitors staff case load and distributes work flow to meet timeliness of service.

*Trains staff in departmental application of benefits, processes, policies and procedures, and assist in training of computer activities.

*Performs departmental activities including but not limited to: assessments, Plan of care development , motivational interviewing, member education, and evaluation of member services.

*Mentors staff in applicable principles and decision-making skills.

*Prepares reports as requested.

*Assist Manager and Director in compliance with regulatory requirements and participates as indicated in audits or surveys by accrediting or oversight agencies.

*Works with providers to educate and assist with applicable processes

*May work with Manager and Director in review of cost analysis of medical expenses.

*Supports implementation of change projects/initiatives. Supports the development and implementation of the department strategic plan.

*Assigns and distributes on-call roster (if needed) to staff and other departments, i.e., member services, Administration.

*Acts as a resource for policies, procedures, and operational changes within the unit.

*Participates in selection, training, and orientation of new employees.

*Performs other functions as required.

Qualifications

Requirements:
Bachelors degree and 3 years of healthcare related experience required. BSN with active RN License or Bachelors degree in health care specialty preferred. Demonstrated management leadership skills. Must have valid drivers license, clean driving record and ability to travel regionally.

Competencies and skills:
Nonessential:
* SKILL-Critical thinking and attention to detail.
* ICD 9 OR 10
* SKILL-Microsoft Office
* Demonstration of high degree of independent problem solving and critical thinking skills.
* SKILL-Ability to deal with all levels of staff and management within the organization, board members, as well as the public, under highly stressful conditions.
* SKILL-Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff using strong dialogue and customer service competencies.
* SKILL-Written communication.

Benefits

Benefits
Benefits are effective day-one (for .45 FTE and above) and include:

  • Competitive salaries
  • Full medical, dental and vision insurance
  • Flexible spending accounts (FSAs)
  • Free wellness programs
  • Paid time off (PTO)
  • Retirement plans, including matching employer contributions
  • Continuing education and career development opportunities
  • Life insurance and short/long term disability programs

About Us
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.

Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.

We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico
New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.

Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.

New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

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Application Instructions

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