Utilization Management RN
Core
Supervising a Utilization Management team to ensure timely, quality, compliant, and cost-effective care for vulnerable seniors by reviewing prior-authorization requests and resolving utilization issues.
Role type
Senior Utilization Management RN Supervisor
Builds
Care delivery processes and authorization workflows for senior care participants
Domain
Senior care / Healthcare administration
Required skills
Clinical nursing experience, Prior-authorization review, Team supervision, Staff mentorship, Provider collaboration, Process improvement
Preferred skills
PACE experience
Technologies
Electronic health records (EHR), Utilization management software
Responsibilities
Direct oversight of day-to-day operations within the designated UM team, Review prior-authorization requests for medical necessity and appropriateness, Identify, develop, and provide orientation and competency development for staff, Collaborate with providers and clinical staff to resolve utilization management issues
Seniority
Senior, hands-on IC with supervisory duties