Job Summary
A company is looking for a Supervisor, Utilization Management.
Key Responsibilities
- Supervises the Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care for members
- Monitors and tracks utilization management resources to ensure adherence to performance, compliance, quality, and efficiency standards
- Collaborates with the utilization management team to resolve complex care member issues and identifies opportunities for process improvements
Required Qualifications
- Graduate of an Accredited School of Nursing or Bachelor's degree
- 4+ years of related experience in utilization management
- Knowledge of utilization management principles preferred
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
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