RN Lead: Acute & Post-Acute Utilization Management

Superior Dental Care, Inc.; Cleveland (OH); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

401(k) with company match up to 4%

Health insurance

Tuition reimbursement up to $5,250 per

PTO and Holidays

Job summary

Medical Mutual in Ohio is seeking a Nurse Reviewer Supervisor to oversee utilization staff and ensure compliant medical necessity decisions for inpatient, concurrent, and retrospective reviews. The role emphasizes evidence-based discharge planning, data-driven improvement, and cross-functional collaboration.

The position requires an Ohio RN license, 7+ years of RN experience in utilization review or case management, and leadership capabilities.

Qualifications

• RN license required (Ohio)
• 7+ years RN experience in health insurance utilization review or case management
• Leadership or project management experience essential

Responsibilities

• Supervise daily operations of utilization staff and provide leadership for retention, efficiency and quality outcomes
• Facilitate interdisciplinary collaboration for utilization management and discharge planning
• Onboard, train, coach and develop staff; apply evidence-based criteria for quality utilization management
• Ensure data gathering for authorizations; monitor data accuracy and timeliness
• Evaluate performance against targets and drive engagement and productivity

Skills

RN license

Leadership

Data analysis

Microsoft Office

Education

Registered Nurse license (OH)

Bachelor's degree preferred

Lean Six Sigma Yellow Belt preferred

Tools

Health insurance knowledge

Job description

Medical Mutual in Ohio is seeking a Nurse Reviewer Supervisor to oversee utilization staff and ensure compliant medical necessity decisions for inpatient, concurrent, and retrospective reviews. The role emphasizes evidence-based discharge planning, data-driven improvement, and cross-functional collaboration.

The position requires an Ohio RN license, 7+ years of RN experience in utilization review or case management, and leadership capabilities.