Utilization Management Supervisor, SCO - Charlestown, MA
at RCM Health Care Services

Date Posted: 2/16/2019

Job Description

Utilization Management Supervisor, SCO - Charlestown, MA
Job Description
The Utilization Management Supervisor, Senior Care Options is a key member of our Dual-eligible Special Needs Plan (DSNP) Senior Care Options product medical management team. The Supervisor is responsible for the daily supervision and operations of the SCO Utilization Management team as the team carries out the requirements of the SCO Model of Care and the contractual requirements.
The Supervisor may carry a caseload based on business needs. This caseload will include the management of prior authorization of services, where required, and concurrent review of inpatient stays. The Supervisor collaborates regularly with the Director of Utilization Management, Plan Medical Directors, SCO Care Management staff and other SCO team members, members' PCPs, requesting providers, and facility care management staff.

Supervision Exercised:
  • 5-10 SCO UM clinical and non-clinical staff
Qualifications:
Education:
  • Nursing degree or diploma required. Bachelor's Degree in Nursing (BSN) preferred
  • Preferred/Desirable:
  • Master's Degree in Nursing or related field
  • Certified Coding Professional (CPC) or other medical coding certification
Experience:
  • 1 year of prior supervisory experience
  • 5 years Registered Nurse experience, including 2 years direct care services and 3 years of any combination of utilization management, discharge planning in an acute care setting, or health plan clinical operations experience at a staff level
Preferred/Desirable:
  • 2 years health plan operations experience with Medicare and/or Medicaid populations, senior care options population highly desirable
  • Health plan operations, experience interacting with providers highly desirable
  • Experience managing exempt and non-exempt staff preferred
  • Knowledge of or experience with community support services
Licensure, Certification 
  • Active unrestricted RN License

Job Snapshot

  • Employee Type: Full-Time
  • Location: Boston, MA
  • Job Type: Management
  • Experience: At least 1 year(s)
  • Date Posted: 2/16/2019

About Us

RCM Health Care Services offers career defining opportunities to candidates from the leading employers in health care. Whether you’re looking for a new job or seeking to hire the best medical talent, RCM Health Care Services has the solution for you. Since 1975, we’ve established ourselves as a leader in the recruitment industry by connecting thousands of healthcare professionals with placements that support their needs. If you’re looking to make the next move in your career, let RCM be your guide, we’re with you every step of the way!

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