RN Utilization Review Supervisor - Care & Compliance

Northeast Georgia Health System; United States; On-site; USD 85,000 - 110,000; Full time

Job summary

Northeast Georgia Health System in Georgia seeks an experienced nurse leader to supervise the Utilization Review department, overseeing precertification, admission, concurrent and retrospective reviews to ensure compliant and efficient patient care.

You will partner with Case Management and Revenue Cycle to improve reimbursement, train staff, analyze KPI data, and ensure adherence to federal and state regulations. Strong communication, leadership, and clinical knowledge are essential.

Qualifications

• Licensure as GA RN with CCM certification.
• Educational requirement: Associates Degree.
• Experience in Utilization Management/Case Management; exposure to third-party payers and regulatory knowledge.
• Experience in healthcare regulations is required.

Responsibilities

• Supervise UR day-to-day operations (precertification, admission, concurrent and retrospective reviews).
• Serve as clinical resource and educate staff on UR policies and government programs.
• Develop, update, and communicate UR policies to support reimbursement goals.
• Assist in recruiting, onboarding, and training UR staff; conduct monthly quality audits.
• Establish and monitor KPIs; provide performance feedback and disciplinary action as needed.
• Review reports to monitor KPI performance and trends; communicate findings to leadership.
• Collaborate with Case Management and other departments to ensure coordination of care and processes.
• Educate physicians on UR policies to ensure safe transitions of care.
• Lead daily team huddles and drive continuous improvement initiatives.

Skills

Leadership

Communication

Organizational skills

Problem solving

Industry knowledge

Staff development

Analytical thinking

Team collaboration

Microsoft Excel

Education

Associates Degree

Tools

Microsoft Office

Job description

Northeast Georgia Health System in Georgia seeks an experienced nurse leader to supervise the Utilization Review department, overseeing precertification, admission, concurrent and retrospective reviews to ensure compliant and efficient patient care.

You will partner with Case Management and Revenue Cycle to improve reimbursement, train staff, analyze KPI data, and ensure adherence to federal and state regulations. Strong communication, leadership, and clinical knowledge are essential.