Nevada Licensed Utilization Supervisor
Job Summary
Supervising a remote team of clinical review professionals, the full-time Nevada Licensed Utilization Supervisor will manage prior authorization, concurrent review, and retrospective review processes, ensuring compliance with healthcare standards while collaborating to resolve complex member care issues.
Key responsibilities:
- Monitors and tracks utilization management resources to ensure adherence to performance, compliance, quality, and efficiency standards
- Collaborates with the utilization management team to identify opportunities for process and quality improvements
- Evaluates team performance and provides coaching, guidance, and feedback to ensure adherence to quality and performance standards
Required qualifications:
- Valid, active, and unrestricted Nevada Registered Nurse (RN) license or a Compact RN license with the willingness to apply for Nevada RN License
- Graduate of an Accredited School of Nursing or Bachelor's degree
- 4+ years of related experience in utilization management or clinical review
- Knowledge of utilization management principles preferred
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