Massachusetts Licensed UM Supervisor

Job Summary

A company is looking for a UM Supervisor, Medicare and Duals.

Key Responsibilities

• Provide leadership and oversight of utilization management functions for Medicare Advantage and One Care/SCO Dual populations
• Supervise a team of clinicians and non-clinical support staff, ensuring compliance with regulatory requirements
• Monitor team performance and facilitate collaboration to promote continuous improvement and member satisfaction

Required Qualifications

• Active Registered Nurse (RN) licensure, with Massachusetts RN License required upon hire
• Minimum 5-7 years of utilization management experience in a health plan/managed care setting
• At least 2 years of supervisory experience preferred
• Experience with integrated Medicare/Medicaid programs such as One Care/SCO or similar models preferred
• Knowledge of Medicare Advantage programs is beneficial