DescriptionHennepin Health is seeking a Nurse, Staff supervisor to join the Utilization Management team. The best candidate will be a motivated self-starter with health plan utilization management and leadership experience, who is able to manage multiple demands, support effective team collaboration, and prioritize work.Hennepin Health is a not-for-profit, state certified health maintenance organization (HMO) and an enterprise initiative of Hennepin County. Hennepin Health serves the county's diverse safety net population and publicly funded health care recipients. Its mission is to help people improve their health through personal service and its vision is to become the leader in eliminating health care disparities. Because of Hennepin Health's affiliation with Hennepin County, services for its members are enhanced through a close linkage with social services and other programs offered by the county.Current Hennepin County employees who refer a candidate hired into an open competitive position may be eligible for a $500 referral bonus. For more information visitemployee referral program. Location and hours:This position is hybrid and may be performed on-site at the Human Services Building located at 525 Portland Avenue, Minneapolis, Minnesota 55415 and remote as job duties require. Work hours will generally be Monday through Friday, between the hours of 8 a.m. – 5 p.m. While this position is designated as hybrid, based on current requirements hires must reside in Minnesota or Wisconsin. New employees who are hired into remote or hybrid positions between January 2, 2022 to December 31, 2024, will receive $500 toward the cost of establishing consistent internet connectivity, payable upon completion of 6 months of employment.About this position type:This is a full-time, benefit-earning position.This position is internally classified as Nurse, Staff.Click here to view the job classification specification. Criminal background checks: Applicants with convictions are not automatically disqualified. Each case is considered on its individual circumstances and the type of work.In this position, you will:
Responsible for performance management of members of the Utilization Management (UM) team.
Provide daily oversight of the UM teams’ work activity to ensure work is performed in accordance with MN state regulation, DHS contract requirements, and Hennepin Health policies and procedures.
Serve as a resource for the UM team and other Hennepin Health teams for medical necessity criteria and benefit interpretation, and authorization processes and practices.
Respond promptly to incoming workload and/or last-minute staff changes and adjust team assignments as necessary to ensure regulatory and contractual requirements are met.
Work in collaboration with the UM manager to ensure work processes and UM policies and procedures are accurate and up to date.
Provide ongoing training and mentoring to staff through one-on-one and group settings.
Perform monthly audits of UM team member reviews and provide feedback to individual team members and UM manager with documented successes or need for improvement.
Take the lead in onboarding new UM team members and develop/coordinate new employee training in collaboration with existing UM team members.
Maintain a case load, as needed.
Need to have:
Graduated from an accredited school of nursing.
Possession of a valid license, in good standing, as a Registered Nurse, or a permit to practice, issued by the State of Minnesota.
Two years or more of experience in:
Direct care experience as a Registered Nurse in a hospital setting and/or experience in home care nursing, clinic, or community clinic.
Supervisory or leadership experience managing cross-functional teams working in a timeline driven environment with competing priorities.
Nice to have:
Use of or familiarity with electronic health records systems (EPIC ®).
Leading workgroups, adult education, and training.
Clinical coding (ICD10, HCPCS, CPT).
Utilization review standards and experience working with state funded (Medicaid) health care programs in a Managed Care Organization
Excellent time management, communication, organization, prioritizing, decision-making, and planning skills
Excel in multi-tasking, including understanding various levels of care, benefit coverage, and health plan product lines
Convey complex or technical information in a manner that various levels of staff can understand.
Work in a collaborative team environment.
Work and sit at computer for long periods
Full range of motion, manual and finger dexterity, and eye-hand coordination
Corrected hearing and vision to normal range
About the department:Hennepin Health provides health care coverage to Hennepin County residents who are enrolled in a Minnesota Health Care Program. Hennepin Health is a nonprofit, state-certified health maintenance organization that contracts with the Minnesota Department of Human Services. We envision being a leader in partnering with our members and communities to improve health, by integrating health care and service to enhance the health and well being of our members and the community. About Hennepin County:Hennepin is the largest county government organization in Minnesota. Our employees work every day to improve the health, safety and quality of life for our residents and communities. All of our jobs align to one or more of our overarching goals -- that Hennepin County residents are healthy, protected and safe, self-reliant, assured due process, and mobile.Our employees receive a combination of generous benefits and positive workplace culture not found at other organizations. This includes meaningful work that impacts our community, competitive pay, work-life balance, a variety of benefits and opportunities to grow. Learn more at The Bridge select Guest.Hennepin County envisions an organization where our commitment to diversity and the reduction of disparities is fundamental in providing excellent service to our community.