The UR Supervisor supervises and directs the pre-certification process and staff assigned to work groups to ensure compliance with the delegated utilization management responsibilities and utilization review license. Responsible for oversight of the daily workflow for Utilization Review Nursing staff and the continuous development of process efficiencies including increased usage of automation. Utilizes reports to monitor daily workload and adjusts team assignments as needed to meet delegated and regulatory time frames for authorization and precertification of medical services. Works collaboratively with UR Quality Delegation Unit to address deficiencies and process improvement/quality improvement plans are implemented when appropriate.
Job Title: Utilization Review Supervisor (LVN)
Clinic Location: Pearland Administrative Office – THIS CAN BE A REMOTE ROLE, AS LONG AS THE CANDIDATE IS LICENSED IN THE STATE OF TEXAS
Department: KCA Utilization Management
Job Type: Full Time
Salary Range: $70,204 – $86,731 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)
Required: 6 Years as a Licensed Vocation Nurse (LVN), CEU requirements.
Preferred: Preceptor Experience
Required: 4 years combined experience as a Utilization Review Nurse, Case Manager or Nurse Preceptor or equivalent experience in a Group practice or other health care setting with responsibility for obtaining authorizations and pre-certifications from health plans.
Computer and Coding experience.
Preferred: 2 years previous supervisory or management experience
Required: Current State LVN license, valid driver’s license
Preferred: 3 years of Kelsey Seybold Clinical Operations experience.
Required: Must possess excellent communication skills. Consistent and prompt attendance is a requirement for this role as this employee works as a part of a care team and the position requires daily interaction with the Medical Staff and other members of the care team.
Required: HMO, PPO and POS Insurance knowledge.
Knowledge of Medicare Advantage and Health plan preauthorization and pre-certification requirements and process.
Ability to work from designated office for collaborative/interactive fulfillment of duties; concentrate in an open-office ‘cubicle’ environment; appropriately and directly interact with other staff members and/or outside associates; perform telephone and/or computer work for extended periods of time; operate office equipment such as a computer, telephone, and copy/scan/fax machine; attend and participate in meetings via phone, computer or in person.
Working Environment: Office/ Medical Clinic
Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.
Why Kelsey-Seybold Clinic?
- Medical, Vision, and Dental
- Tuition Reimbursement
- Company Matching 401K
- Employee Reward and Recognition Program
- Paid time off for vacation, sick, and holidays
- Employee Assistance Program
- Continuing Medical Education allowance
Utilization Review Supervisor (LVN)