Supervisor, Utilization Management

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

📋 Description

• Oversee the Clinical Review teams involved in Prior Authorization, Concurrent Review, and/or Retrospective Review.

• Manage daily operations of the utilization management team.

• Track and evaluate UM resources regarding performance, compliance, quality, and efficiency.

• Work collaboratively with the utilization management team to address complex member care issues.

• Stay informed about regulations, accreditation standards, and industry best practices.

• Identify opportunities for process and quality enhancements.

• Provide education and resources to the utilization management team.

• Supervise clinical review nurses to ensure adherence to guidelines, policies, and procedures.

• Develop and implement UM policies, procedures, and guidelines in partnership with senior management.

• Assess team performance and offer feedback on objectives and career development.

• Coach and mentor team members.

• Assist with the onboarding, recruitment, and training processes.

• Lead and advocate for changes within the designated scope of responsibility.

• Execute other assigned tasks and adhere to policies and standards.

⛳️ Requirements

• Graduate from an accredited nursing school or possess a Bachelor's degree with 4+ years of relevant experience.

• Preference for knowledge of utilization management principles.

• RN - Registered Nurse - State Licensure and/or Compact State Licensure is mandatory.

• For Health Net Federal Services: a current, active licensure or certification to perform independent assessments is required.

• For Health Net Federal Services (Medical Management): a Certified Managed Care Nurse (CMCN) credential is required within 1.5 years.

• For Health Net Federal Services: U.S. citizenship and a current National Agency Check government security clearance are required.

🏝️ Benefits

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements including remote, hybrid, field, or office options.

• Competitive salary.

• Additional incentive programs may be included in total compensation.