Supervisor, Utilization Management

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

📋 Description

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

• Manage the daily operations of the utilization management team.

• Track and monitor UM resources to ensure performance, compliance, quality, and efficiency.

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

• Stay updated on regulations, accreditation standards, and industry best practices.

• Identify opportunities for process and quality improvements.

• Provide education and resources to the utilization management team.

• Supervise nursing staff and ensure adherence to relevant guidelines, policies, and procedures.

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

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

• Mentor and support team members.

• Assist with onboarding, recruitment, and training processes.

• Lead and advocate for change initiatives.

• Carry out other assigned responsibilities and comply with established policies and standards.

⛳️ Requirements

• Must be a resident of Oklahoma.

• An active RN license is mandatory.

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

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

• Experience in utilization management is essential.

• Willingness to participate in weekend on-call coverage is required.

• Proficient in Microsoft Office applications.

• Technologically adept.

• Excellent communication and customer service skills are necessary.

• Strong attention to detail is essential.

• Possess organizational and management skills.

• Effective time management abilities are required.

• Knowledge of utilization management principles is preferred.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off in addition to holidays.

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

• Competitive salary.

• Additional incentive programs may be included in total compensation.

• An equal opportunity employer committed to fostering diversity.