Utilization Review Supervisor

Jobtailor; Deutschland; Vor Ort; EUR 60.000 - 90.000; Vollzeit

Zusammenfassung

InterMed is seeking aRN/LVN-licensed leader to manage the Utilization Review team across all offices, ensuring timely requests and productive workloads. You will provide coaching, conduct reviews, and maintain compliance with UR guidelines and applicable labor codes.

You will work closely with the Medical Director, oversee training, and drive QA initiatives while fostering collaboration with Intercare and client organizations.

Qualifikationen

• Minimum of three years of clinical experience.
• Minimum of three years of leadership or supervisory experience.
• Experience in California Workers' Compensation Utilization Review and related regulations.
• Progressive technical experience with complex case guidance.
• Current, unrestricted RN or LVN license in the state of residence.

Aufgaben

• Plans, assigns, and directs the work of the Utilization Review team for all InterMed offices.
• Determines appropriate caseloads to meet timeliness and productivity expectations.
• Provides ongoing mentoring, coaching, and performance feedback to staff.
• Produces timely performance reviews for personnel in the unit.
• Addresses personnel issues promptly and informs supervisor of progress.
• Authorizes time-off requests to maintain coverage and service guidelines.
• Performs weekly audits of UR reviews to validate accuracy and completeness.
• Acts as InterMed's compliance officer, ensuring adherence to state and URAC regulations.
• Participates in the Quality Management Program Committee with quarterly reviews.
• Monitors patient safety concerns and escalates to the proper authority.
• Ensures knowledge of Utilization Review guidelines per applicable Labor Codes.
• Collaborates with Medical Director to ensure UR guideline compliance.
• Oversees training of staff on computer systems and UR policies.
• Provides training for Intercare claims team at various locations to ensure workflow.
• Maintains professional image and promotes teamwork across departments.
• Communicates clearly in writing and verbally with injured workers, examiners, and clients.
• Maintains production and savings reports for management review.
• Leverages AI and productivity tools for project management and reporting.
• Performs other duties as assigned by leadership.

Kenntnisse

Leadership

Supervisory experience

Utilization Review

Team management

Jobbeschreibung

Responsibilities

• Plans, assigns, and directs the work of the Utilization Review team for all InterMed offices, including day‑to‑day operational oversight.
• Determines appropriate caseloads that allow for timeliness of requests and productivity that meets expectations.
• Provides ongoing advice, mentoring, coaching, counseling, and performance feedback to assigned staff.
• Completes performance reviews for all personnel within the assigned unit in a timely manner.
• Deals quickly and decisively with personnel issues as they arise; keeps the supervisor informed on the need for, or progress of, corrective action.
• Authorizes time‑off requests to ensure coverage necessary to maintain service guidelines.
• Performs weekly audits of more than 10% of reviews per UR Nurse to validate accuracy and completeness of the utilization review process, and conducts comparable periodic audits of Medical Management Coordinator work product.
• Serves as InterMed's compliance officer, ensuring compliance with state and URAC regulations.
• Participates as an active member of InterMed's Quality Management Program Committee, including quarterly meetings to discuss program improvements, measurements, assessments, and compliance.
• Maintains awareness of potential compromise to a patient's safety on each review and refers concerns to the proper authority.
• Requires comprehensive knowledge of Utilization Review guidelines in the California Labor Code and other states as needed.
• Works with the Medical Director to ensure compliance with Utilization Review guidelines.
• Oversees training of new staff on computer systems and on UR policies and procedures.
• Provides training for Intercare claims team at various locations to ensure timely and accurate workflow.
• Exhibits a knowledgeable and helpful attitude and projects a professional image on behalf of InterMed and Intercare.
• Fosters teamwork and cooperation between UR staff and other departments at InterMed, Intercare, and client organizations.
• Notifies the supervisor of potential client issues and works toward resolution.
• Assists with the implementation of new accounts, with input from account management, and supports staff compliance with client service instructions.
• Works effectively with peers across departments, demonstrating professionalism, respect, and a team‑oriented approach.
• Uses plain language to communicate, in writing and verbally, with injured workers, claims examiners, and clients.
• Maintains production performance and savings reports for management review.
• Leverages AI and office productivity tools to support project management and reporting workflows.
• Handles other duties and tasks as assigned by leadership.

Requirements

• Minimum of three years of clinical experience.
• Minimum of three years of leadership or supervisory experience.
• Minimum of one year of California Workers' Compensation Utilization Review experience, including working knowledge of the California Workers' Compensation Labor Code and regulations, and other states as needed.
• Progressive technical experience demonstrating sound judgment and discretion, with the ability to provide guidance on complex cases.
• Current, unrestricted RN or LVN license in the state in which the employee resides.