New York State Licensed Utilization Supervisor

Job Summary

Supervising a remote team of clinical reviewers, the full-time New York State Licensed Utilization Supervisor will oversee prior authorization, concurrent review, and retrospective review processes, ensuring compliance with quality and performance standards while collaborating with team members to improve care delivery.

Key responsibilities

• Monitor and track utilization management resources to ensure adherence to performance and compliance standards
• Collaborate with the utilization management team to resolve complex member care issues
• Evaluate team performance and provide coaching and feedback to ensure quality standards are met

Required qualifications

• Active New York State Registered Nurse (NYS RN) licensure at the time of application
• Graduation from an Accredited School of Nursing or a Bachelor's degree
• 4+ years of related experience in utilization management or clinical settings
• Knowledge of utilization management principles preferred