Supervisor, Utilization Management

## Supervisor, Utilization ManagementApply: Remote-AZ: Vendor - Phoenix, AZ: Full time: Posted Today: **Position Purpose:** Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team.* Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards* Collaborates with utilization management team to resolve complex care member issues* Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management* Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management* Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers* Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures* Works with the senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services* Evaluates utilization management team performance and provides feedback regarding performance, goals, and career milestones* Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards* Assists with onboarding, hiring, and training utilization management team members* Leads and champions change within scope of responsibility* Performs other duties as assigned* Complies with all policies and standards**Education/Experience:** Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience. Knowledge of utilization management principles preferred. **License/Certification:** * RN - Registered Nurse - State Licensure and/or Compact State Licensure required* For Health Net Federal Services: Must have current and active licensure or certification that permits independent assessment required* For Health Net Federal Services (Medical Management): Certified Managed Care Nurse (CMCN) within 1-1/2 Yrs required* For Health Net Federal Services: US citizenship and current National Agency Check government security clearance requiredPay Range: $75,300.00 - $135,400.00 per year
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