What to expect

The Utilization Management & Appeals Clinical Supervisor will provide clinical expertise in the areas of utilization management, clinical appeals, and behavioral health. The role of the clinical supervisor is to support the Utilization Management (UM) manager in the areas of payor authorizations, appeals for denials, team management and the financial revenue cycle.

Additional responsibilities include:

Provides oversight of the daily workflow and functions of the utilization management team at both hospital campuses to ensure that all processes within the department are in alignment with the organizational goals.
Assists in the development and strategies to help improve the utilization management process, and the overall quality improvement for utilization management operations.
Serves as an internal resource for applying medical necessity criteria and evidence-based clinical guidelines.
Manages the appeal and denial process during the preservice and concurrent review phase of the client's inpatient stay to enhance reimbursement and reduce avoidable write-offs.

What you'll get from us

At Sheppard Pratt, you will work alongside a multi-disciplined team led by a bold vision to change lives. We offer:

A commitment to professional development, including a comprehensive tuition reimbursement program to support ongoing education and licensure and/or certification preparation
Comprehensive medical, dental and vision benefits for benefit eligible positions
403b retirement match
Generous paid-time-off for benefit eligible positions
Complimentary Employee Assistance Program (EAP)
Generous mileage reimbursement program
Pay for this position is determined on a number of factors, including but not limited to, years and level of related experience.

What we need from you

Bachelor's degree in nursing, Master's degree in counseling or social work.
Must possess one of the following active licenses in the state of Maryland at time of hire and maintain continuously throughout tenure in the position: RN, LCPC or LCSWC.
3-5 years of experience in behavioral health, utilization review, and/or medical management.
Experience with oversight and development of team workflows, and educational materials to enhance the quality of the authorization process.
Strong knowledge of payer requirements, clinical guidelines, and regulatory standards.
Familiarity with denial management software or appeal tracking tools.
If the candidate holds a RN license: In keeping with the Maryland Board of Nursing guidelines, all nurses must have an active Maryland nursing license to practice in the state of Maryland, or must have an active license in a compact state that allows them to practice in Maryland, if they reside in that compact state. A multistate licensee who changes primary state of residence to another party state shall apply for a multistate license in the new party state within 60 days. The rule requires that a nurse apply for a new license in a new primary state of residence within 60 days of relocating, it does not require the new license be issued withing 60 days.

WHY SHEPPARD PRATT?

At Sheppard Pratt, we are more than just a workplace. We are a community of healthcare professionals who are dedicated to providing hope and healing to individuals facing life's challenges. Join us and be a part of a mission that changes lives!

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.