Supervisor, Utilization Management - Operations

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

This position is accountable for the day-to-day and strategic activities of the assigned review coordinator team. This position is also accountable for achieving results and maintaining flexibility to meet business needs. Responsibilities include the supervision of team members, ensuring that strategic processes are established, communicated and accomplished, and facilitating interdepartmental communications. This position resides in Health Management yet interacts regularly with other business segments within Medica. This position assists in developing, maintaining, executing, and overseeing of end-to-end operational processes for triage and processing of all provider-related submissions and questions related to inpatient notification and discharge information and prior authorizations. In addition, this position is responsible for process documentation and implementation, facilitating process improvement opportunities, and on-going maintenance of departmental processes.

The Supervisor, Utilization Management - Ops oversees a team of Review Coordinators who serve as a central point of contact for operational issue identification, escalation, and resolution. This role drives operational excellence by identifying and implementing process improvements across Utilization Management and related departments, coordinating cross-functional initiatives, and ensuring resources are aligned to support business objectives. The Supervisor plays a key role in the development, planning, and execution of departmental and enterprise projects that support Utilization Management operations.

The Supervisor, Utilization Management - Ops is responsible for the day-to-day leadership and performance of the assigned team, ensuring operational goals, service standards, and business objectives are achieved. This role establishes and communicates strategic priorities, fosters collaboration across departments, and supports organizational agility in response to evolving business needs. Positioned within Health Management, the Supervisor partners regularly with leaders and teams across Medica to drive effective outcomes and continuous improvement.

Key Accountabilities:

Supervision-Daily Operations

• Ensures workflow is efficient and effective. Ensures requests are completed within department standards and comply with regulatory guidelines.
• Identifies and assists in resolution of escalated and/or complex issues. Tracks and trends issues and completes root cause analysis
• Communicates and implements department/team changes and decisions
• Oversees team functions including, but not limited to, timecard approval, personal time off reviews, etc.
• Facilitates start to end hiring process. Includes interviews, appropriate paperwork and onboarding schedule
• Maintains accessibility and availability to facilitate problem solving and resolution of case reviews and complex issues
• Ensures policy and procedures are effectively managed and implemented
• Develops new and oversee the monitoring and updating of department SOPs (standard operating procedures). Collaborates with team and communicates as needed
• Demonstrates ability to prioritize and distribute high volume of requests, communicates plan to team as needed
• Identifies and initiates process improvements
• Assists in department process improvement planning, implementation and training related to audit findings and Corrective Action Plans
• Supports daily operations and long-range planning for department
• Collaborates with department and all business segments to ensure consistent, effective and timely communication occurs
• Works with internal and external stakeholders to ensure accurate system set-up and maintenance

Staff Supervision- Direct Reports

• Communicates accurate and timely information to team members to enhance the effectiveness and efficiency of performance
• Encourages staff to identify potential areas for improvement and work efficiencies. Identifies streamlining opportunities
• Provides technical support by researching and responding timely to complex questions and issues
• Provides ongoing coaching and development for new and existing team members on a regular basis. Assesses and develops colleagues for success
• Provides both positive and constructive feedback with prompt training and/or coaching if necessary
• Performs regular audits on scope of work to ensure department guidelines, processes and turn-around times are being followed
• Conducts regular one on one meetings to discuss performance and opportunities for improvement and growth as needed
• Sets individual performance goals and facilitate the creation of individual learning plans
• Prepares and presents performance reviews annually
• Provides recognition to individuals through reward and recognition programs

Project Management

• Oversees a variety of related projects: complex initiatives and projects, large-scale Health Management initiatives, key or high-visibility cross-department initiatives
• Identifies requirements and expectations, defines deliverables, and develops project work-plans (including time and resources commitments) with department/business segments. Tracks and communicates project status with department/business segments
• Understands and communicates the key strategic or operational purpose of projects. Develops content expertise on assigned projects
• Contacts and coordinates resources (other departments) to resolve identified issues in an effective and timely manner
• Anticipates issues and potential obstacles. Assists department/business segments in identifying appropriate solutions
• Participates as business SME (subject matter expert) on system projects that impact department core processes
• Conducts effective meetings, including development of agendas and meeting minutes
• Performs other duties as assigned

Required Qualifications:

• Bachelor's degree or equivalent combination of education and work experience
• 3+ years of direct leadership experience, either through managerial experience or through leadership roles that require coaching, mentorship and performance evaluation
• 3+ years healthcare experience

Preferred Qualifications:

• Prior leadership experience in Utilization Management, Prior Authorization, or related health plan operations
• Experience leading and developing teams in a virtual, metrics-driven environment
• Demonstrated experience coaching, mentoring, and developing employees, including performance management and annual performance reviews
• Experience leading change initiatives and implementing operational processes that improve performance, efficiency, and business outcomes
• Experience managing projects and driving cross-functional initiatives from planning through execution.

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, or St. Louis, MO.

The full salary grade for this position is $70,200 - $120,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $70,200 - $105,315. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.