McLaren Health Care Spvr Medical Mgmt in Indianapolis, Indiana
MDwise, Inc. Opportunity – Medical Management Supervisor – Utilization Management
MDwise is your local, Indiana-based nonprofit health care company. We were founded in 1994 to help vulnerable populations needing health coverage in Indiana. Our parent organization, McLaren Health Care at https://www.mclaren.org/main/home.aspx , is a nonprofit integrated health system who believes all Indiana families should have access to high quality health care regardless of income. Our mission is to provide high quality health care. MDwise works with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs.
MDwise is seeking the right individual to join our team in our Medical Management department. As an employee of MDwise, you will be a part of a dynamic organization that considers all of our employees as leaders in driving the organization forward and delivering quality service to all our members.
The Medical Management Supervisor for Utilization Management will be responsible for providing supervision to UM Nurses to ensure accuracy and consistency of medical reviews. They will provide supervision of staff and function to meet organizational goals in utilization, disease, case, and medical management. Ongoing monitoring of assigned department performance standards regarding timeliness, appropriateness, and cost effectiveness. Is the recognized resource of the department for problem solving, including research and implementation of sound clinical decision making. The primary focus for daily responsibilities includes utilization and case management process review and oversight for assigned products for all duties. Works diligently with staff to ensure the delivery of quality services at the most appropriate and cost-effective setting. Assists where necessary or through project management those business ventures undertaken by the Company to ensure its profitable future.
Current Valid RN License
Bachelor’s Degree in nursing or related field. An equivalent combination of relevant education and experience may be substituted for the educational requirement
Two (2) years’ experience in a supervisory role for a staff of five or more members leading or assisting in all phases of effective supervision (ie. Recruitment, performance management, training)
Two (2) years’ experience in utilization review and/or case management
Two (2) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g. medical delivery, regulatory compliance, claims processing, membership/eligibility, risk arrangements, etc.)
Available to work a flexible schedule to meet organizational needs
- Experience developing and presenting training materials
Primary Location: Indiana-Indianapolis-MDwise Inc
Employee Status Regular
Job Type Standard
Req ID: 20008241