Supervisor, Utilization Management (RN)
Core
Supervises Prior Authorization, Concurrent Review, and Retrospective Review Clinical Review teams to ensure appropriate care to members and manages day-to-day utilization management activities.
Role type
Supervisor, Utilization Management (RN)
Builds
Healthcare service utilization review processes and compliance frameworks
Domain
Healthcare administration / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Utilization management principles, Clinical review guidelines, Regulatory compliance, Team performance evaluation, Process improvement, Staff coaching and training
Preferred skills
Knowledge of utilization management principles
Technologies
None stated
Responsibilities
Monitor and track UM resources for performance and compliance; Collaborate to resolve complex care member issues; Maintain knowledge of regulations and accreditation standards; Identify opportunities for process and quality improvements; Educate team on key initiatives; Monitor clinical review nurses for guideline adherence; Develop and implement UM policies and procedures; Evaluate team performance and provide feedback; Assist with onboarding, hiring, and training; Lead change initiatives
Seniority
Mid-level Supervisor, hands-on management