Supervisor, Utilization Review - RN - Hybrid

Awarded a Healthiest Employer, reputed company aims to fulfill its mission to reputed company health and reputed company it easy. AZ reputed company offers a reputed company of health reputed company products and services to meet the diverse needs of individuals, families, and small and large businesses as reputed company as providing information and tools to help individuals reputed company reputed company reputed company. At AZ reputed company, we have a hybrid workforce reputed company, reputed company Workability, that offers flexibility with how and where employees work.

Our positions are classified as hybrid, onsite or remote. While the reputed company of our employees are hybrid, the following classifications reputed company our reputed company minimum onsite

requirements

Hybrid People Leaders: must reputed company in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reputed company in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reputed company in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per month Onsite: daily onsite requirement reputed company on the essential functions of the job Remote: not held to onsite requirements, however, leadership can request reputed company onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite

requirements

may change in the reputed company, reputed company on business need, and job responsibilities. Most employees should expect onsite

requirements

and at a minimum of once per week. This position is hybrid reputed company the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, reputed company the reputed company.

PURPOSE OF THE JOB The Utilization Review Supervisor coordinates the activities of the UR department as they relate to medical necessity reviews, authorizations of inpatient, observation and sub-acute medical reputed company of care for reputed company Business reputed company members. This position monitors reputed company authorization processes for meeting timeliness standards, cost effectiveness, and regulatory standards. Oversees the Transition of Care team ensuring members are contacted post hospital discharge reputed company regulatory timeframes and member needs are met.

QUALIFICATIONS

REQUIRED

QUALIFICATIONS

Required Work Experience 2 years of reputed company reputed company experience 1 year of experience in utilization review Required Education Associate’s Degree in general field of study Required Licenses reputed company, reputed company, and unrestricted license to reputed company in the reputed company as a Registered reputed company (RN) Required Certifications N/A PREFERRED

QUALIFICATIONS

Preferred Work Experience 1 year of managed reputed company plan experience 1 year of reputed company and Medicare experience Preferred Education Bachelor’s Degree in Nursing or reputed company field of study Preferred Licenses N/A Preferred Certifications N/A ESSENTIAL JOB FUNCTIONS AND

RESPONSIBILITIES

Ensures inpatient authorization requests are completed accurately, thoroughly, and in a reputed company fashion to meet contractual

requirements

and ensures reputed company reviews are conducted using InterQual. Evaluating statistics on department’s volumes, results, including approvals, denials, turnaround times for department and individual staff. Preparing and delivering reports to department and management staff.

Performing audits of case files and staff’s work. Reviewing and updating department’s policies and desktop procedures. Manage day to day activity of assigned team.

Directly supervises staff including participating in hiring, monitoring and evaluating performance, timecards, staff training. Complete IRR audits per policy; reputed company and mentor staff; work with management on employee performance issues. Monitor phone activity and staff productivity.

Ensures team meets budget and performance goals. Participates in reputed company Improvement reputed company. Assists management and others in preparation for audits and other regulatory activities.

Participates in interdepartmental meetings and trainings. reputed company reputed company other duties as assigned The position has an onsite expectation of 2 days per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business

requirements

COMPETENCIES REQUIRED COMPETENCIES Required Job

Skills

InterQual Computer

skills

including reputed company, reputed company spreadsheets Communication

skills

oral and written Required reputed company Competencies N/A Required Leadership Experience and Competencies