Overview M Health Fairview has an immediate opening for a Utilization Management Supervisor. This is a 1.0 FTE (80 hours per two week pay period), salaried/exempt role. This position is benefits-eligible. The Utilization Management Supervisor is responsible for the supervision and maintenance of the daily functions of Utilization Management Team. The incumbent, reporting to the Manager of Utilization Management, will primarily be responsible for managing the UM nursing staff in the day to day operations of the department. This includes oversight and adjustment of work queues and assignments when needed to maintain work flow balance, monitoring and implementing adherence to department metrics, training of new hires and on-going education, managing staff to performance expectations for the department including coaching and counseling and various other responsibilities to support the nursing and liaison UM staff. He/she will work closely with the management staff and will play a key role in implementing the culture and work environment that promotes and inspires an active, continuous improvement philosophy with regard to the Fairview Strategic Plan, mission, vision and values. Responsibilities Job Description The Utilization Management Supervisor is responsible for the supervision and maintenance of the daily functions of Utilization Management Team. The incumbent, reporting to the Manager of Utilization Management, will primarily be responsible for managing the UM nursing staff in the day to day operations of the department. This includes oversight and adjustment of work queues and assignments when needed to maintain work flow balance, monitoring and implementing adherence to department metrics, training of new hires and on-going education, managing staff to performance expectations for the department including coaching and counseling and various other responsibilities to support the nursing and liaison UM staff. He/she will work closely with the management staff and will play a key role in implementing the culture and work environment that promotes and inspires an active, continuous improvement philosophy with regard to the Fairview Strategic Plan, mission, vision and values. Trains new team members and performs ongoing training of existing team. Monitors performance of team and individual team members and takes appropriate action to ensure department goals are met. Performs utilization management in accordance with all policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Evaluates patient progress daily via chart review and/or collaboration with care transitions specialist. Obtains necessary medical reports and subsequent treatment plan requests to conduct ongoing reviews. Evaluates patient progress daily via chart review and/or collaboration with care transitions specialist. Obtains necessary medical reports and subsequent treatment plan requests to conduct ongoing reviews. Collaborates with health care team partners, including care transition specialists, Care Coordinators, physicians, clinicians, payers, non-clinical staff, HIMs, central business office, admissions, patient placement and clinical managers on level of care, identified barriers, reimbursement issues, and other issues related to utilization management activities. Ensures Medicare guidelines are followed including facilitation of appeals related to medical necessity or appropriateness. Acts as financial steward by optimizing the patient’s medical benefits, as well as optimizing reimbursement. Understands and follows system and facility UM Plans. Works with Compliance to ensure documentation meets regulatory requirements Participates in interdisciplinary communication related to utilization review issues. Educates on status. Eliminates risk for denials or underpayments ensuring care at the correct level and providing timely communication of clinical information to appropriate providers. Collects data and other information required by payers to fulfill utilization and regulatory requirements. Tracks all work related to denials/appeals. Mentors internal members of the health care team on utilization management and managed care concepts. Facilitates integration of concepts into daily practice. Understands and focuses on key performance indicators. Provides all customers with excellent service experience. Completes all initial and annual required learning relevant to role. Complies with all relevant laws, regulations, and policies. Contributes to a safe work environment. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, and appropriateness of treatment setting by utilizing InterQual and Fairview approved guidelines. Applies clinical knowledge to work with facilities and providers for utilization review. Works with medical directors in interpreting appropriateness of status and accurate claims payment. May also manage appeals for services denied. Conducts pre-surgery, inpatient, and outpatient/observation and retrospective appropriateness of treatment setting reviews to ensure compliance with applicable criteria. Consult with clinical UM Specialists and Liaisons and/or medical directors to ensure medically appropriate, high quality, cost effective levels of care. Mentors, leads and directs staff including day-to-day supervision, schedule, employee relations and staff development * Adheres to established productivity standards, participates in departmental performance improvement activities and work level Organization Expectations, as applicable: Demonstrates ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served Partners with patient care giver in care/decision making. Communicates in a respective manner. Ensures a safe, secure environment. Individualizes plan of care to meet patient needs. Modifies clinical interventions based on population served. Provides patient education based on as assessment of learning needs of patient/care giver. Fulfills all organizational requirements Completes all required learning relevant to the role Complies with and maintains knowledge of all relevant laws, regulation, policies, procedures and standards. Fosters a culture of improvement, efficiency and innovative thinking. Performs other duties as assigned Qualifications Required Education AS/BS in nursing Experience 3 years of utilization review experience. Working knowledge of utilization management and quality improvement. License/Certification/Registration Current Registered Nurse license in the state of Minnesota. Preferred Education BS in nursing Experience Prefer prior experience in a lead area or managing cross functional teams on large projects. Three to five years utilization review or case management experience in hospital, clinic, long term care facility or insurance company. EEO Statement EEO/AA Employer/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status Benefit Overview

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link for additional information: https://www.fairview.org/careers/benefits/noncontract

Compensation Disclaimer The posted pay range is for a 40-hour workweek (1.0 FTE). The actual rate of pay offered within this range may depend on several factors, such as FTE, skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization values pay equity and considers the internal equity of our team when making any offer. Hiring at the maximum of the range is not typical.