Supervisor, Utilization Management (RN)

Responsibilities

• Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
• Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
• Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers
• Makes sure prior authorization, concurrent review, and/or retrospective clinical review nurses comply with applicable guidelines, policies, and procedures
• Develops and implements utilization management policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
• Evaluates utilization management team performance and gives feedback regarding performance, goals, and career milestones
• Assists with onboarding, hiring, and training utilization management team members
• Leads and champions change within scope of responsibility

Requirements

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

Qualifications

• Knowledge of utilization management principles preferred

Skills

• Compliance with all policies and standards

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.