Supervisor, Utilization Management

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

📋 Description

• Oversee the Clinical Review team for Prior Authorization, Concurrent Review, and/or Retrospective Review.

• Manage the daily operations of the utilization management team.

• Track and assess UM resources for their performance, compliance, quality, and efficiency.

• Work alongside the utilization management team to address intricate member care concerns.

• Stay informed on utilization management regulations, accreditation benchmarks, and industry best practices.

• Identify opportunities for process enhancement and quality improvement in collaboration with the team and senior management.

• Provide education and resources on significant initiatives while facilitating communication among the team, members, and providers.

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

• Collaborate with senior management to develop and implement UM policies, procedures, and guidelines.

• Assess team performance and offer constructive feedback regarding performance, objectives, and career progression.

• Mentor and support team members in achieving quality and performance benchmarks.

• Assist with onboarding, recruitment, and training of team members.

• Lead and advocate for change within the defined scope of responsibilities.

• Perform additional tasks as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Graduate from an Accredited School of Nursing or possess a Bachelor's degree with 4+ years of relevant experience.

• A valid, active, and unrestricted Nevada Registered Nurse (RN) license is required.

• Candidates with a Compact RN license will be considered if they are willing to obtain a Nevada RN license.

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

• Familiarity with utilization management principles is preferred.

• Availability from Monday to Friday, 8 AM to 5 PM PST.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

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

• Additional incentives may be part of the total compensation package.

• Equal opportunity employer dedicated to diversity.