Supervisor, Utilization Management - Remote

Overview

The Supervisor, Utilization Management is responsible for overseeing the UM Department, ensuring quality patient care outcomes, and managing staff to meet CMS compliance requirements.

In Short

• Lead the Utilization Management team in a fast-growing healthcare company.
• Ensure compliance with CMS and internal standards.
• Conduct and supervise telephonic concurrent reviews.
• Manage staff performance and development.
• Collaborate with healthcare professionals for patient care.
• Implement care plans tailored to individual member needs.
• Maintain accurate documentation and reporting.
• Oversee the auditing process for quality assurance.
• Participate in developing policies and procedures.
• Work Pacific Time hours.

Requirements

• Minimum 1 year of supervisory experience in a healthcare setting.
• At least 2 years of experience in managed care.
• Valid RN license in California; LVN/RN licenses in additional states preferred.
• Knowledge of Medicare Managed Care Plans.
• Proficiency in Microsoft Office Suite.
• Experience with clinical criteria applications.
• Strong communication and leadership skills.
• Ability to manage multiple priorities effectively.
• Commitment to patient-centered care.
• CCM or ABQAURP certification preferred.

Benefits

• Opportunity to make a significant impact in senior care.
• Room for growth and innovation within the company.
• Supportive and mission-focused team environment.
• Competitive salary and benefits package.
• Reimbursement for additional state licensure.
• Equal opportunity employer.
• Comprehensive training and onboarding process.
• Flexible work environment.
• Access to professional development resources.
• Commitment to employee well-being and support.