Supervisor, Utilization Management
Core
Supervises Prior Authorization, Concurrent Review, and Retrospective Review Clinical Review teams to ensure appropriate care to members.
Role type
Senior Utilization Management Supervisor
Builds
Healthcare utilization management processes and compliance standards
Domain
Healthcare administration / Utilization Management
Required skills
Clinical review oversight, Performance monitoring, Regulatory compliance, Process improvement, Team coaching, Policy development
Preferred skills
Utilization management principles knowledge
Technologies
Healthcare regulations frameworks, Accreditation standards
Responsibilities
Monitor UM resources for performance and compliance adherence, Collaborate to resolve complex care member issues, Maintain knowledge of regulations and best practices, Identify opportunities for process and quality improvements, Educate team on key initiatives, Monitor clinical review nurses for guideline compliance, Develop and implement UM policies and procedures, Evaluate team performance and provide feedback, Assist with onboarding, hiring, and training, Lead and champion change initiatives
Seniority
Senior, hands-on IC