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Supervisor - Utilization Review: Corp - Utilization Review

Company

Memorial Healthcare System
Address , Hollywood, Fl
Employment type
Salary
Expires 2023-07-21
Posted at 11 months ago
Job Description
Summary:
Under the direction of the Director, supervises the department¿s activities and resources to ensure alignment with the mission, values, and objectives of the department and organization.
Detailed responsibilities:
  • Supervises the UR Staff¿s daily operations to ensure that utilization review is performed timely, accurately and in compliance with appropriate regulatory bodies. Escalates issues to Director as needed.
  • Monitors department operations, including information technologies, service level determination and complaint management, to achieve performance and quality control.
  • Assists UR Director in implementing departmental goals, plans, and standards consistent with the clinical, administrative, legal and ethical requirements of the organization.
  • Assists UR Director in planning and monitoring staffing activities, including hiring, orienting, evaluating, disciplinary actions and continuing education initiatives.


Competencies and skills:
Essential:
  • EFFECTIVE COMMUNICATION: Communicates effectively with various audiences using the most appropriate method for the situation.
  • RESPONDING TO CHANGE: Accepts change and adapts in a positive and productive manner; handles unexpected situations and changes in direction calmly and with confidence. Views new assignments and job responsibilities as an opportunity for growth.
  • ACCOUNTABILITY: Accepts ownership of job roles and specific assignments/goals; works independently, takes responsibility for own actions; admits mistakes and judgment errors; and accepts constructive feedback. Connects personal work results to the accomplishment of team and organizational goals.
  • CUSTOMER SERVICE: Demonstrates commitment to service excellence by promptly addressing internal/external customer issues/requests, resolving concerns while maintaining a professional image and behavior to build and enhance the patient/family/customer experience.
  • ANALYSIS AND DECISION MAKING: Uses decision making processes and tools to analyze situations and make effective decisions.
  • STANDARDS OF BEHAVIOR: Acts in a manner that supports the standards of communication, respect, privacy, and teamwork by demonstrating a commitment to professional and ethical conduct.
  • MANAGING PEOPLE: Uses HR/Performance Management processes and systems to align individual performance to achieve organizational results.

Education:
Essential:
  • Accredited Program

Education specialization:
Essential:
  • Nursing


Credentials:
Essential:
  • Registered Nurse License


Other information:
Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. May require specialized knowledge of a business line.
Required Work Experience: 3 years leadership experience and 2 years experience in utilization case management.
Working conditions:
Essential:
  • Computer Monitor 80.00%
  • Lifting or Carrying 0 - 25 lbs Non-Patient 60.00%
  • Depth Perception 80.00%
  • Seeing - Near 80.00%
  • Squatting 40.00%
  • Walking 80.00%
  • Audible Speech 80.00%
  • Kneeling 40.00%
  • Pushing or Pulling 0 - 25 lbs Non-Patient 60.00%
  • Distinguish Color 80.00%
  • Bending and Stooping 60.00%
  • Hearing Acuity 80.00%
  • Sitting 80.00%
  • Standing 80.00%
  • Repetitive Movement Hand/Arm 80.00%
  • Reaching 60.00%
  • Keyboard Entry 80.00%
  • Seeing - Far 80.00%

Organizational Profile:


Since its inception in 1953, Memorial Healthcare System has been a leader in providing high-quality healthcare services to South Florida residents. Today, it is one of the largest public healthcare systems in the nation with over 13,000 team members and highly regarded for its exceptional patient- and family-centered care. Memorial's patient, physician and employee satisfaction rates are some of the most admired in the country, and the system is recognized as a national leader in quality healthcare.


Memorial has a reputation as one of Florida's leading healthcare systems and is supported by a distinguished medical staff. In fact, the vast majority of physicians are board certified or board qualified in their specialties and have been trained at many of the nation's finest medical schools and hospitals. Because of its distinguished medical staff and services, Memorial draws patients from South Florida and beyond.


Many prestigious healthcare awards have been earned by Memorial Healthcare System and its facilities. The accolades include: Modern Healthcare magazine's Best Places to Work in Healthcare, Florida Trend magazine's Best Companies to Work for in Florida, 100 Top Hospitals, Consumer Choice Award, Best-Run Hospital, Best Nursing Staff, Best Pediatric Hospital and Best Maternity Hospital.


Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.