MO Licensed Utilization Management Supervisor

Job Summary

Supervising a clinical review team, the full-time MO Licensed Utilization Management Supervisor will manage prior authorization, concurrent review, and retrospective review processes to ensure appropriate care for NICU members in a remote setting.

Key responsibilities

• Monitor and track utilization management resources to ensure compliance with performance and quality standards
• Collaborate with the utilization management team to resolve complex care member issues and identify process improvements
• Provide coaching and guidance to team members, ensuring adherence to guidelines and facilitating ongoing education

Required qualifications

• Graduate of an accredited nursing school or Bachelor's degree
• 4+ years of related experience in utilization management
• Current RN license in the state of Missouri or compact state licensure
• Knowledge of utilization management principles preferred