Supervisor, Utilization Management (RN)

Responsibilities

• Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
• Works with the senior management to develop and implement UM policies, procedures, and guidelines
• Evaluates utilization management team performance and provides feedback
• Assists with onboarding, hiring, and training utilization management team members
• Collaborates with utilization management team to resolve complex care member issues
• Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards
• Works with the utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
• Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures
• Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards
• Works with the utilization management team to educate and provide resources for key initiatives
• Leads and champions change within scope of responsibility

Requirements

• Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience
• Knowledge of utilization management principles preferred
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Qualifications

• Complies with all policies and standards

Skills

• Knowledge of utilization management principles

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• A flexible approach to work with remote, hybrid, field or office work schedules

Pay

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives.

Schedule

Actual schedule may vary based on business needs and may include remote, hybrid, field or office work.