RN Licensed Utilization Management Supervisor

Job Summary

Supervising a remote team, the full-time RN Licensed Utilization Management Supervisor will manage prior authorization, concurrent review, and retrospective review processes to ensure appropriate member care while overseeing daily operations and team performance.

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 policies and facilitating ongoing communication with members and providers

Required qualifications:

• Graduate of an accredited nursing school or a Bachelor's degree
• 4+ years of related experience in utilization management
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required
• Knowledge of utilization management principles preferred