Remote Supervisor, Utilization Management, Multiple Locations - Remote Eligible

✨ About The Role

- Supervise Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members - Monitor and track UM resources to ensure adherence to performance, compliance, quality, and efficiency standards - Collaborate with utilization management team to resolve complex care member issues - Develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services - Evaluate utilization management team performance and provide feedback regarding performance, goals, and career milestones

⚡ Requirements

- Experienced clinical professional with a background in nursing or a related field, ideally with 5-8 years of experience in utilization management - Strong leadership skills to supervise and mentor a team of clinical review nurses, ensuring adherence to quality and performance standards - Ability to collaborate with senior management to identify opportunities for process and quality improvements within utilization management - Detail-oriented individual with knowledge of regulations, accreditation standards, and industry best practices related to utilization management - Excellent communication skills to educate and provide resources for the utilization management team, members, and providers