Licensed Utilization Management Supervisor

A company is looking for a Supervisor, Utilization Management. Key Responsibilities Lead and coach utilization management licensed staff and support teams Ensure prior authorization determinations comply with regulatory and contractual SLAs Monitor performance indicators and manage daily inventory for efficient operations Required Qualifications Minimum 5 years of supervisory experience in utilization management or prior authorization Licensed RN, with multi-state licensure preferred Three to five years of experience in Medicare/Medicaid or commercial health plans Experience in outpatient and inpatient prior authorization processes In-depth knowledge of Medicare and Medicaid coverage criteria and compliance requirements

Mar 25, 2025 - 14:27

A company is looking for a Supervisor, Utilization Management. Key Responsibilities Lead and coach utilization management licensed staff and support teams Ensure prior authorization determinations comply with regulatory and contractual SLAs Monitor performance indicators and manage daily inventory for efficient operations Required Qualifications Minimum 5 years of supervisory experience in utilization management or prior authorization Licensed RN, with multi-state licensure preferred Three to five years of experience in Medicare/Medicaid or commercial health plans Experience in outpatient and inpatient prior authorization processes In-depth knowledge of Medicare and Medicaid coverage criteria and compliance requirements