Supervisor, Care Coordination

This is a fully remote position, open to applicants in Florida.

📋 Description

• Supervise the daily activities of the utilization management team.

• Ensure adherence to regulatory requirements, organizational policies, and best practices within the industry.

• Foster staff development and track performance outcomes.

• Advocate for high-quality, cost-efficient care coordination.

• Guide and assist a team of Referral Coordinators across various health plans.

• Ensure conformity with utilization management procedures.

• Assess eligibility for benefit coverage.

• Collaborate with both internal and external stakeholders to enhance patient care.

• Partner with health plan case managers and claims payers to ensure effective care coordination.

• Guarantee precise claims processing.

⛳️ Requirements

• Bachelor's degree in Nursing (BSN), Healthcare Administration, or a related field.

• A minimum of 3–5 years of experience in utilization management, case management, or a similar healthcare context.

• At least 2 years of leadership or supervisory experience in a healthcare setting.

• Strong knowledge of utilization management, medical necessity criteria, and regulatory compliance (e.g., CMS, NCQA, URAC).

• Required to adhere to compliance principles as outlined in the Code of Conduct and related policies.

• Must engage in mandatory Corporate Compliance Program training initiatives annually or as needed.

• Proficient in Microsoft Word, Excel, and PowerPoint.

• Exceptional leadership, problem-solving, and decision-making skills.

• Strong communication and interpersonal abilities for effective cross-functional collaboration.

• Comprehensive understanding of healthcare regulations and UM guidelines.

• Strong leadership, team management, and coaching capabilities.

• Previous experience in a supervisory or leadership role within a healthcare environment.

• Preferred associate degree or higher in Health Administration or a related discipline.

🏝️ Benefits

• Medical, Vision, Dental insurance.

• Short- and Long-term insurance.

• More than 6 days of holiday pay.

• 13 days of paid time off (PTO).

• Employer-sponsored life insurance.

• 401K plan with employer contribution.

• Wellness program with reward incentives.

• Employee recognition and reward initiatives.

• Comprehensive paid training program.