Supervisor Utilization Review RN

About the role

You supervise utilization review for RNs, overseeing processes daily, guiding on complex cases, identifying staff education opportunities, and connecting departments through communication.

Responsibilities

• Supervising Utilization Review Department, assigning tasks, assessing productivity, conducting quality reviews, and advising team on peer-to-peer appeals
• Conducting denial research and collecting data to generate weekly reports that aid in improving staff outcomes and enhancing quality metrics
• Collaborating with the Medical Director and Care Coordination when patients don't meet criteria
• Updating Clinical Resource Manager as needed
• Assigning daily tasks to staff members to ensure service levels are maintained at an optimal level
• Monitoring daily observation reports to identify and address any potential problems
• Handling escalations from Utilization Review Nurses and other staff members
• Conducting quality reviews as needed
• Responding to inquiries from staff members and stakeholders regarding Utilization Review
• Serving as a Subject Matter Expert (SME) for Utilization Review workflow issues, complex cases, denials, and customer interactions, both internal and external

Requirements

• Possessing a helpful nature that assists others in identifying and solving challenges
• Skilled in mentoring and encouraging colleagues for the enhancement of their clinical proficiency
• Exceptional written and conversational abilities
• Proficient at collaborating effectively with employees of varying ranks, including those at the highest level of leadership
• Familiarity with discharge planning, case management, and utilization review processes, case handling and the review of resource usage
• Experience in strategically directing work among team members based on established policies and protocols
• Aptitude in making sound hiring and termination suggestions
• Proficiency in training colleagues and assessing their performance
• Basic digital skills like using Microsoft Office, information security, managing schedules and payroll, electronic medical documentation, and email use

Qualifications

An Associate's Degree in Nursing and 4 years of experience are required.