Clinical Supervisor, Utilization Management

Company: VNS Health
Location: New York
Posted on: February 13, 2025

Job Description:

Overview Supervises and coordinates the day-to-day business operations of clinical and non clinical support activities, including monitoring internal processes, coordinating activities between the clinical and non-clinical staff, and supervising support functions to facilitate efficient clinical operations. Makes recommendations on operational improvements for the department. Works under general supervision.What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities What You Will Do
  • Supervises the day-to-day operations of VNS Health Plans Medical Management clinical and non clinical staff. Makes recommendations to the development, utilization, and evaluation of internal processes to ensure customer satisfaction, efficient operations, and accurate and timely resolution for all complaints and issues.
  • Monitors workflow procedures and systems for an efficient and timely operation that is responsive to customers (members, discharge planners, VNS Health employees, physicians, families, etc.) and operational needs. Troubleshoots difficult customer service issues, facilitates problem resolution and directs staff in addressing and resolving day-to-day operational issues.
  • Assists management team in the development of long- and short- range objectives for department, which includes system and operational rollouts and coordination of non clinical support functions to facilitate effective clinical operations.
  • Provides input to the Education and and Quality department regarding training needs for new initiatives. Participates in the overall planning, implementation and evaluation of such programs.
  • Works with management to develop and implement strategies and actions to improve the quality of the team's performance, which includes participation in workflow reengineering, process improvement, risk mitigation and computer application development activities.
  • Ensures adherence to regulatory and VNS Health Plans standards to ensure compliant operations and department's readiness for internal and external audits.
  • Oversees business operations, workflows, utilization and schedules; contributes to systems design and implementation; and participates in developing standards to measure, maintain and maximize efficiencies and meet operational needs.
  • Performs all duties inherent in a supervisory role. Ensures effective staff training, interviews candidates for employment, evaluates staff performance, and recommends hiring, promotions, salary actions, and terminations as appropriate. Qualifications Licenses and Certifications:
    • License and current registration to practice as a Registered Professional Nurse in New York State or Licensed Social Worker RequiredEducation:
      • Bachelor's Degree in Nursing or other health related degree for RNs Required
      • Master's Degree in Social Work for LSW RequiredWork Experience:
        • Minimum three years progressive customer service or business operations experience, preferably in a health care environment. Required
        • Supervisory experience Preferred
        • Proficient in Personal Computers applications, including Microsoft Word and Excel Required
        • Knowledge of medical terminology, pharmacology information and /or insurance terminology Required
        • Strong knowledge of operations of manual and automated office systems and procedures Required
        • Strong knowledge of third party payer requirement for reimbursement Preferred
        • Strong operational skills with attention to detail Required Compensation $93,400.00 - $116,800.00 Annual About Us VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us-we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 "neighbors" who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.

Keywords: VNS Health, New York , Clinical Supervisor, Utilization Management, Executive , New York, New York