RN Utilization Review Lead (Clinical Supervisor)

El Paso Health; El Paso (TX); On-site; USD 85,000 - 110,000; Full time

Job summary

University Medical Center of El Paso is seeking an RN Supervisor to oversee the day-to-day medical necessity, authorization, and clinical review functions within the Health Services Department.

You will coordinate with Case Management and Pharmacy to streamline authorizations and support timely, high-quality patient care across Medicaid, CHIP, Medicare, and Commercial lines. Direct supervision of UR staff and continuity with compliance are essential.

Qualifications

• Oversees medical necessity, authorization, and clinical review.
• Monitors adherence to policies and licensure.
• Requires RN with Texas license and BSN.
• Experience in UR/UM in managed care preferred.

Responsibilities

• Supervise Clinical Reviewers (RNs/LVNs) to ensure timely, accurate coverage decisions.
• Coordinate with Case Management and Pharmacy for authorizations.
• Ensure cross-departmental coordination across plan lines (Medicaid, CHIP, Medicare, Commercial).
• Oversee UR, compliance, and workflow reporting.

Skills

RN supervision

Utilization review

MS Office (Word/Excel/PowerPoint)

Clinical policy interpretation

Communication skills

Time management

Diversity & cultural sensitivity

Education

BSN

Tools

MCG guidelines

InterQual

CMS regulations

Job description

University Medical Center of El Paso is seeking an RN Supervisor to oversee the day-to-day medical necessity, authorization, and clinical review functions within the Health Services Department.

You will coordinate with Case Management and Pharmacy to streamline authorizations and support timely, high-quality patient care across Medicaid, CHIP, Medicare, and Commercial lines. Direct supervision of UR staff and continuity with compliance are essential.