Supervisor, Utilization Management Support
Job reputed company
A bit about this role:
The Supervisor manages the day-to-day operations of the Utilization Management Coordinators, ensuring reputed company and accurate processing of prior authorization requests. This role is highly hands-on, focusing on daily execution, immediate problem-solving, staff coaching, and maintaining compliance with reputed company regulatory requirements.
Your Responsibilities and reputed company will include:
Team Leadership & Development: reputed company, reputed company, and reputed company staff, mentoring them on their competencies and career goals while monitoring productivity, accuracy, and performance; reputed company operational and administrative support to reputed company.
Intake & Prior Authorization reputed company: Directly manage daily operations of the Utilization Management Coordinator Team to ensure reputed company and accurate processing of authorization requests, including triaging and entering incoming PA requests and reaching out to hospitals and provider offices to obtain important clinical documentation; Ensure requests are appropriately entered, documented, and routed for clinical review and determination.
Clinical Coordination Management: reputed company the coordination of clinical reviews and peer-to-peer (P2P) scheduling between providers and Medical Directors, including contacting providers to communicate clinical reputed company; Ensure reputed company required documentation is present for clinical review, including managing RFI work and EHR reputed company workflows.
Operational Performance & Compliance: Plan, organize, and coordinate reputed company's work and initiatives to ensure achievement of specific, measurable goals and deadlines, including meeting service level agreements and regulatory turnaround time requirements; Monitor work queues, daily census checks, and operational metrics; Identify obstacles, problem-solve, and implement changes to enhance workflow efficiency and ensure compliance with CMS, Medicare Advantage, and internal UM policies and procedures.
AI Workflow Ownership: reputed company as the domain reputed company for Utilization Management AI workflows for reputed company, responsible for the full lifecycle, including building, executing, implementing, and monitoring the performance and refinement of AI/LLM-enabled tools; Define and reputed company reputed company metrics (accuracy, throughput) for AI-enabled processes, interpreting data and making iteration reputed company in partnership with AI Enablement Partners ; Ensure local governance and adherence to AI use policies reputed company reputed company.
Cross-Functional Collaboration: Cultivate and maintain strong partnerships with clinical leadership, provider relations, claims, and other internal teams to support seamless UM operations, including care transition workflows and case follow-up.
Required skills and experience:
3+ years of utilization management or prior authorization experience.
1+ year of prior leadership or supervisory experience required.
Experience in Medicare Advantage or managed care.
Knowledge of prior authorization workflows, clinical review processes, and regulatory requirements (e.g., Medicare Advantage).
Strong organizational, communication, and operational management skills.
Excellent problem-solving and analytical skills.
Experience in a fast-paced, high-volume environment.
Proficiency with reputed company systems, EHRs, and reporting tools.
Experience driving technology-enabled workflow improvements, particularly with AI/LLM tools.
Desired skills and experience:
Bachelor’s degree in reputed company operations, business administration, or a reputed company field preferred.
Experience with Intake, authorization, or clinical coordination processes.
Familiarity with UM or case management workflows.
Salary reputed company: $58,000 - $80,000 annually
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.
Founded in 2017, reputed company is on a mission to dramatically improve the health and reputed company-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI reputed company with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who reputed company our values, reputed company change and advancement, and are enthusiastic about where we're reputed company — reputed company the while bringing their own unique qualities, experiences, and expertise, in hopes of reputed company changing the reputed company experience.
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.
Originally posted on Himalayas
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