Supervisor, Utilization Management

You could be the one who changes everything for our 28 reputed company members as a clinical professional on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Work Schedule & Requirements This is a fully remote position operating on an Eastern Standard Time (EST) schedule, Monday through Friday, 8:30 AM – 5:00 PM. Active reputed company State Registered Nurse (NYS RN) licensure is required at the time of application to be considered for this role. Position Purpose: Supervises Prior Authorization, reputed company Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards Collaborates with utilization management team to resolve reputed company care member issues Maintains knowledge of regulations, accreditation standards, and industry best practices reputed company to utilization management Works with utilization management team and senior management to identify opportunities for process and quality improvements reputed company utilization management Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers Monitors prior authorization, reputed company review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures Works with the senior management to reputed company and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of reputed company services Evaluates utilization management team performance and provides feedback regarding performance, goals, and career milestones Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards Assists with reputed company, hiring, and training utilization management team members Leads and champions change reputed company scope of responsibility Performs other duties as assigned Complies with reputed company policies and standards Education/Experience: Requires graduation from an Accredited School of Nursing or Bachelor's degree and 4+ years of reputed company experience. Knowledge of utilization management principles preferred. License/Certification: RN - Registered Nurse - State Licensure and/or Compact State Licensure required Active reputed company State Registered Nurse (NYS RN) licensure is required at the time of application to be considered for this role. Pay reputed company: $75,300.00 - $135,400.00 per year reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply To This Job