RN Supervisor, Appeals, Managed Care, UM
Core
Supervises clinical review teams (Prior Authorization, Concurrent Review, Retrospective Review) to ensure appropriate care for members and manages utilization management operations.
Role type
Senior Utilization Management Supervisor
Builds
Clinical review processes and utilization management policies for healthcare members
Domain
Healthcare / Managed Care / Utilization Management
Required skills
Utilization management principles, appeals process management, clinical review oversight, regulatory compliance, team performance evaluation, policy development, staff coaching
Preferred skills
Managed care environment experience, process improvement, change management
Technologies
None stated
Responsibilities
Monitor UM resources for performance and compliance; resolve complex care member issues; maintain knowledge of regulations and accreditation standards; identify process improvement opportunities; educate the UM team on initiatives; monitor clinical review nurses for guideline adherence; develop and implement UM policies; evaluate team performance; provide coaching and guidance; assist with onboarding and training; lead change initiatives
Seniority
Senior, hands-on IC with management responsibilities