Utilization Management Clinical Supervisor

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The UM (Utilization Management) Department supports our clients and company through utilizing clinical criteria to approve or deny a service based on the authorization. The UM Supervisor plays a crucial role in ensuring that healthcare services provided to members are appropriate, efficient, and effective.

A Utilization Management Supervisor is responsible for guiding a group of employees to achieve specific goals and objectives. They ensure effective communication within the team. Additionally, they monitor performance, provide feedback, and support professional development to enhance team productivity. Supervisors also play a crucial role in resolving conflicts, fostering a positive work environment, and coordinating with other departments to ensure alignment and successful project completion. Their leadership helps drive the team’s success and contributes to the overall growth of the company.

As a Utilization Management Supervisor, you will play a pivotal role in managing and supporting a team of remote employees. Your responsibilities will include overseeing Prior Authorizations, and/or Retrospective Review that the Clinical Review team completes to ensure appropriate care to members. You will supervise day-to-day activities of Utilization Management team including assisting with questions, reviewing client-based letters, conducting monthly client reporting, and analyzing trends of UM reports. You will perform monthly audits on your team to ensure compliance and quality and conduct one-on-one coaching sessions with your Lead to foster their professional growth. Also, you will help with upkeeping internal department documents and review questions and concerns from other departments within the company. When necessary, you will perform testing and train your staff members. You will process prior authorization requests when necessary to meet turnaround times. Your leadership and organizational skills will be essential in maintaining team efficiency and achieving departmental goals.  

 

Competencies:   

• Self-Motivation & Organization: Must be self-motivated and highly organized with the ability to work autonomously without direct supervision. 

• Flexible Hours: Work hours will be determined by your manager and may vary based on location, department needs, and workflow. Additional hours outside of normal shifts may be required. 

• Deadline Adherence: Expected to meet established deadlines and deliver high-quality work consistently.  

• Virtual Collaboration: Use virtual platforms like Teams and Microsoft Outlook for collaboration. Participate and conduct monthly/quarterly check-ins and bi-weekly department touch …