Massachusetts RN Utilization Supervisor

Job Summary

Massachusetts RN Utilization Supervisor is a full-time remote position responsible for overseeing daily operations of Medicare Advantage utilization management staff, providing coaching and evaluation, and participating in organizational projects.

Key Responsibilities

• Oversee clinical inpatient and outpatient utilization management reviews and ensure compliance with documentation guidelines
• Monitor staff productivity, adjust assignments, and report trends to management
• Develop tools and workflows to enhance the accuracy and completeness of reviews and documentation

Required Qualifications

• Bachelor's Degree in a related field required (experience may substitute for degree)
• Massachusetts Registered Nurse (RN) license
• Certified Case Manager (CCM) preferred
• 3-5 years of relevant experience in a managed care setting with knowledge of utilization management
• Leadership and/or supervisory experience preferred