Supervisor(a) Operacional De Utilizacion
Regular
Exempt
GENERAL DESCRIPTION:
Oversees and monitors the administrative operations of the Utilization Management unit, ensuring effective management of the precertification process in accordance with organizational standards. Provides direct supervision to Utilization Management Coordinators, ensuring service delivery aligns with company policies and regulatory requirements. Promotes team collaboration and continuous process improvement to meet operational goals.
ESSENTIAL FUNCTIONS:
- Lead regular staff meetings to communicate updates on operations, projects, and improvements.
- Facilitate collaboration between departments to enhance service continuity.
- Manage department workload by prioritizing tasks and allocating resources efficiently.
- Ensure compliance with company policies, procedures, and relevant laws and regulations.
- Assist in developing and implementing departmental goals and strategies aligned with company priorities.
- Support operational changes by providing training and guidance to team members.
- Review and update operational guidelines to maintain accuracy and regulatory compliance.
- Analyze and report on precertification metrics to identify opportunities for process enhancements.
- Supervises, monitors, trains, evaluates, and corrects personnel among others to comply with his/her role as a supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and that they behave following the policies, standards, norms, and procedures of the Company.
- Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
- May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
MINIMUM QUALIFICATIONS:
Education and Experience: Associate's degree in Health Administration, Business Administration, Healthcare Management, or a related field. At least four (4) years of experience in administrative and operational processes related to utilization management, prior authorization, preferably within the health insurance industry. At least one (1) year of experience supervising personnel is required.
“Proven experience may be replaced by previously established requirements.”
Certifications / Licenses: N/A
Other: Knowledge of clinical criteria, ICD-9, CPT, and HCPCS coding systems.
Languages:
Spanish – Advanced (comprehensive, writing and verbal)
English – Intermediate (comprehensive, writing and verbal)
“We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.”
