Post-Acute UM Supervisor

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the Post-Acute Utilization Management (UM) team, which includes responsibilities for hiring, scheduling, training, performance management, coaching, and implementing corrective actions.

• Track and respond to essential UM and operational metrics (such as timeliness, approval/denial trends, readmissions, length of stay, and throughput), recognizing patterns and fostering performance enhancement.

• Ensure the consistent application of InterQual criteria and CMS/Medicare Advantage guidelines in post-acute review decisions.

• Conduct quality audits and maintain documentation integrity while ensuring compliance with regulatory and health plan standards.

• Collaborate with clinical leadership and IT/analytics teams to deploy and improve AI/LLM-supported workflows (including clinical summarization, decision support, documentation assistance, and queue prioritization).

• Promote workflow standardization and identify opportunities for automation to boost efficiency and enhance the staff experience.

• Facilitate education and orientation for new and existing personnel regarding post-acute UM processes and tools.

⛳️ Requirements

• A current unrestricted RN license with a minimum of 4 years of clinical experience.

• At least 3 years of experience in utilization management within a health plan or managed care environment.

• A minimum of 1–2 years of supervisory or team leadership experience.

• A working knowledge of AI/LLM tools and their utilization in clinical or UM workflows.

• Familiarity with InterQual criteria and/or other evidence-based guidelines for medical necessity.

• An understanding of CMS regulations and Medicare Advantage requirements.

🏝️ Benefits

• Employer-sponsored health, dental, and vision plans with low or no premium.

• Generous paid time off policy.

• A monthly stipend of $100 for mobile or internet expenses.

• Stock options available for all employees.

• Bonus eligibility for all positions excluding Director and higher; commission eligibility for Sales roles.

• Parental leave program.

• 401K retirement plan.

• And more....