Utilization Management Supervisor - Remote

Overview

The Utilization Management Supervisor is responsible for overseeing the operations of the Utilization Management Department, ensuring efficient authorization of healthcare services while maintaining compliance with regulations.

In Short

• Lead and coach utilization management licensed staff and support teams.
• Ensure prior authorization determinations meet regulatory and SLA requirements.
• Monitor key performance indicators and quality of reviews.
• Manage outpatient and inpatient prior authorizations.
• Oversee daily inventory and workforce management.
• Develop and deliver training programs for UM staff.
• Communicate with clients and providers regarding determinations.
• Manage escalated cases and client inquiries.
• Collaborate on process improvements and regulatory updates.
• Ensure achievement of departmental quality improvement goals.

Requirements

• Minimum 5 years supervisory experience in utilization management.
• Licensed RN with multi-state licensure preferred.
• Experience in Medicare/Medicaid or commercial health plans.
• Strong communication skills with excellent grammar and diction.
• Proficient in MS Office and basic computer skills.
• Strong investigative and critical thinking skills.
• Ability to lead a high-performing team.
• In-depth knowledge of Medicare and Medicaid criteria.
• Experience in discharge planning and care transition management.

Benefits

• People-first approach to work environment.
• Opportunities for professional development.
• Collaborative team culture.
• Focus on quality services and client satisfaction.