Supervisor - Utilization Review

Position Summary

This role involves assisting and supervising a multidisciplinary team with the day-to-day management of the Utilization Review Services and team members. Responsibilities include coordinating staff schedules, managing workflows, procedures, and protocols, researching and resolving patient/provider issues, conducting performance evaluations, and participating in service delivery.

Responsibilities

• Manage team responsible for completing utilization management programs, processes, and tasks.
• Edit, maintain, and implement policies and procedures that meet regulatory requirements and business needs.
• Implement and facilitate curriculum and ongoing training in collaboration with education specialists.
• Maintain daily case management statistics and reporting.
• Research and manage team member and patient complaints.

Requirements

• Bachelor of Science or higher in Nursing is required.
• Master of Science in Nursing is preferred.
• Two or more years' experience in Utilization Review is required.
• Experience with evidence-based clinical guidelines including MCG (Miliman) and/or InterQual is preferred.

Pay

$79,664.00 - $116,116.00