RN Supervisor of Utilization Management

Job Summary

A company is looking for a Supervisor of Utilization Management.

Key Responsibilities

• Supervise and mentor a team of Utilization Review Nurses, ensuring high-quality clinical reviews
• Collaborate with leadership to develop and maintain utilization management policies and procedures
• Monitor team performance and ensure compliance with regulatory requirements and accreditation standards

Required Qualifications

• 5+ years of Utilization Management or Quality Improvement experience in managed care
• 2+ years of clinical experience in an acute care or surgical hospital setting
• Active RN license in the state of residence
• Proficient in ICD-10, CPT, HCPCS, Revenue codes, and CMS/URAC guidelines
• Familiar with evidence-based criteria such as MCG and health plan policies