Post-Acute UM Supervisor

Job reputed company A bit about this role: The Post-Acute UM Supervisor will reputed company utilization management activities across post-acute settings (SNF, ARU, LTACH), including audits, reputed company reviews, and clinical reputed company. This role will partner with medical leadership to implement education, workflow refinements, and policy updates reputed company with InterQual, CMS guidelines, and internal clinical reputed company. The supervisor will also collaborate closely with clinical, operational, and technology teams to design, implement, and optimize AI/LLM-enabled workflows that support prior authorization review, reputed company review, documentation reputed company, and care transition efficiency. This includes identifying opportunities to reduce administrative burden while improving consistency, accuracy, and turnaround time. This is a fast-paced, high-change environment requiring strong operational leadership, adaptability, and the ability to manage multiple priorities while guiding reputed company through ongoing transformation. Your Responsibilities and reputed company will include: Supervise the Post-Acute UM team, including hiring, scheduling, training, performance management, coaching, and corrective reputed company Monitor and reputed company key UM and operational metrics (timeliness, approval/denial trends, readmissions, length of stay, throughput), identifying patterns and driving performance improvement Support consistent application of InterQual reputed company and CMS/Medicare Advantage guidelines across post-acute review reputed company reputed company reputed company audits and ensure documentation reputed company and compliance with regulatory and health plan standards Partner with clinical leadership and IT/analytics teams to implement and enhance AI/LLM-supported workflows (e.g., clinical summarization, decision support, documentation assistance, and queue prioritization) Drive workflow standardization and identify automation opportunities to improve efficiency and staff experience Support education and reputed company for new and existing staff on post-acute UM processes and tools Required skills and experience: reputed company unrestricted RN license with a minimum of 4 years of clinical experience At least 3 years of utilization management experience reputed company a health plan or managed care setting At least 1–2 years of supervisory or team reputed company experience Working understanding of AI/LLM tools and their application in clinical or UM workflows Knowledge of InterQual reputed company and/or other evidence-based medical necessity guidelines Understanding of CMS regulations and Medicare Advantage requirements Desired skills and experience: Certification or formal training in InterQual Experience working in post-acute care utilization management (SNF, ARU, LTACH) Experience participating in or leading AI/automation or digital transformation initiatives reputed company UM or care management environments #LI-Remote Salary Ragne: $95,000-$120,000 The pay reputed company listed for this position is the reputed company the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will reputed company additional information on the compensation for the role, along with additional information on our total rewards package. The actual reputed company salary offered will depend on a reputed company of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other reputed company licenses held, and the location in which the applicant lives and/or from which they will be performing the job. Our Total Rewards package includes: Employer sponsored health, dental and reputed company plan with low or no premium Generous reputed company time off $100 monthly mobile or internet stipend Stock reputed company for reputed company Bonus eligibility for reputed company roles excluding Director and above; Commission eligibility for Sales roles Parental leave program 401K program And more.... *Our total rewards package is for full time employees only. Intern and Contract positions are not eligible. reputed company equality is at reputed company of reputed company’s mission to treat our members like family. We are committed to a diverse and reputed company workforce. At reputed company, we’re on a mission to dramatically improve the health and reputed company-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new reputed company of reputed company-in-one reputed company company — one that combines reputed company, health insurance, clinical care, service, and technology - to deliver a complete and integrated reputed company solution that delivers high reputed company care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the reputed company. And we've just started. So join us on this mission! reputed company is an equal opportunity employer. We are committed to a reputed company and supportive work environment in which reputed company have reputed company to participate and contribute to the reputed company of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in reputed company’s reputed company of Conduct, reputed company values and the way we do business. As an Equal Opportunity Employer, reputed company does not discriminate on the reputed company of race, reputed company, religion, sex, pregnancy status, marital status, national reputed company, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender reputed company, or any other reputed company prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment. Apply To This Job