Senior Utilization Manager, Acute & Post-Acute

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

Benefits offered by this job

On-site fitness centers

Gym membership reimbursement

Brooklyn HQ on-site cafeteria

Employee discounts

Cash rewards for shopping with our 고객

Job summary

Medical Mutual is seeking a nurse reviewer supervisor to lead the utilization staff in a hybrid Brooklyn, OH location. The role focuses on applying medical necessity guidelines for inpatient, concurrent, and retrospective reviews, and coordinating discharge planning for timely transitions between care levels.

The ideal candidate will have an RN license in Ohio, 7+ years in utilization review or case management, and experience leading teams.

Qualifications

• Must be a graduate of a registered nursing program approved by the Ohio State Nursing Board.
• 7+ years progressive RN experience in health insurance utilization review or case management.
• Experience leading teams or projects.

Responsibilities

• Supervises daily operations of assigned utilization staff and provides leadership to improve retention, efficiency, and quality outcomes.
• Fosters interdisciplinary collaboration for utilization management and discharge planning.
• Supports onboarding, training, coaching, and professional development; applies evidence-based criteria for quality utilization management.
• Ensures data gathering for authorizations; tracks trends and ensures timeliness of decisions; oversees internal controls.
• Evaluates performance against targets and drives engagement and results.
• Coordinates system processes with providers, partners, vendors, and subcontractors as needed.
• Ensures compliance with policy, procedures, and state/federal regulations.

Skills

MS Office

Healthcare systems

HIPAA knowledge

Data analysis

Change management

Education

RN license in Ohio

BSN or Healthcare Admin preferred

Lean Six Sigma Yellow Belt preferred

Job description

Medical Mutual is seeking a nurse reviewer supervisor to lead the utilization staff in a hybrid Brooklyn, OH location. The role focuses on applying medical necessity guidelines for inpatient, concurrent, and retrospective reviews, and coordinating discharge planning for timely transitions between care levels.

The ideal candidate will have an RN license in Ohio, 7+ years in utilization review or case management, and experience leading teams.