Promise Ship

Utilization Management Supervisor

Location: Nebraska - Omaha
Employment Status: Full time

Description

Are you looking for a great place to work with a flexible schedule, excellent benefits, competitive pay and a chance to make a difference? PromiseShip is a fast-paced organization that embraces change and has a huge sense of purpose. We are looking for individuals who are motivated, compassionate and enthusiastic about helping children and families.

PromiseShip works to make children and families safe and healthy while creating a thriving environment. We have an awesome benefits package, promote community involvement, wellness, cultural growth, training, opportunities to learn and grow, and above all – have some fun while we do it. The work we do is challenging and rewarding. We offer:

  • An engaging culture
  • On site Company Kitchen and free coffee
  • Wellness program
  • Comfortable office setting next to a park and walking trail
  • Employee recognitions
  • Quarterly off-site All Staff gatherings
  • Family Picnics, soup cook-offs, football party days
  • Routinely On-site: Yoga Classes, Massage Therapists, Food Trucks
  • Monthly On-site: Midland Pet Therapy Day
  • Training and development opportunities
  • Team atmosphere
  • Did I mention a great, comprehensive benefit package and competitive pay?

If you are forward thinking, creative with a strong sense of purpose, PromiseShip is the place for you.

 

Utilization Management Supervisor

PromiseShip is currently seeking a Utilization Management Supervisor to develop and oversee processes for ensuring resource maximization through the appropriate authorization of services, approve requests for service authorization to ensure the documentation supports expenditure of funds and provide oversight to referral/network provider tasks, as needed.

 The ideal candidate will:

  • Oversee the authorization management system and interactions with the PromiseShip Family Permanency Specialist and Family Permanency Specialist Supervisors.  Reviews initial, concurrent and reauthorization requests for all paid services and the process of authorizing valid service requests per policy.
  • Leads the evaluation of the rationale for services/placements, and need for additional services with consideration of the child/family’s circumstance and the provider’s ability to meet the service need or provide support with alternate planning.
  • Develops and implements the approved criteria or evidence-based guidelines in determining the necessity of service/placements requests.
  • Interacts with  Family Permanency Specialists, Supervisors and  subcontractors via telephone, fax and email to request additional information, clarify a service request, and coordinate care or to provide authorization for services per policy.
  • Prepare, coordinate and submit appropriate information to Leadership when unable to validate the necessity of the service requested per policy.
  • Be responsible for monitoring referral patterns and making recommendations on strategies to contain costs, improve access and insure quality care.
  • Monitor and analyzes the use of services from PromiseShip subcontractors.
  • Ensures cost effective and quality care by appropriate utilization of resources.
  • Maintains ongoing compliance with federal, state or Federal laws, COA standards and other regulatory agencies as evidenced by documented compliance with the policies and procedures set forth by PromiseShip.
  • Assists the Operations Support Director with ongoing development and implementation of the UM program and the Performance and Quality Improvement program policies and procedures.
  • Participate in the  Performance and Quality Improvement Program as requested.  This may include collecting data, identifying processes in need of improvement, implementing policy and/or process changes, etc.
  • Assist in the organization and facilitation of  Provider meetings.

Requirements:

  • A Master’s degree in psychology, social work, nursing or medical field, health education, or a related human services field plus a minimum of 3 years of experience in the delivery of services to families and children is required; or Bachelor’s degree with 2 years of proven program management experience strongly preferred.
  • Familiarity with utilization review or case management highly desired.
  • Must be knowledgeable of the various types of funding, familiar with community resources and service providers within the geographical area.
  • Able to rely on extensive experience and judgment to plan and accomplish goals.
  • Ability to interpret, adapt, and apply guidelines and procedures independently.
  • Must demonstrate ability to maintain professional working relationships with youth, families, staff and the general public.
  • Detail-oriented with excellent verbal and written communication skills.
  • Strong organizational skills and attention to detail strongly desired.
  • Must possess computer experience and competency in a Windows-based environment and ability to learn and utilize other software programs.
  • Must possess valid driver's license with a good driving record.

Equal Opportunity Employer





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