Utilization Review Clinical Supervisor, El Paso Health

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

• Facility University Medical Center of El Paso
• Department EPH Health Services
• Schedule - Shift - Hours Full Time - Days

Job Summary

Oversees the day-to-day medical necessity, authorization, and clinical review functions within the Health Services Department, ensuring UR Associates apply established medical policies, clinical guidelines, and plan benefit criteria consistently and within scope of licensure. Coordinates closely with Case Management to support seamless care transitions and with the Pharmacy Department to streamline medication-related authorizations, helping ensure each member receives appropriate, high-quality care in a timely manner. Oversees UR, compliance, and cross-departmental coordination across all health plan lines of business, including Medicaid (STAR, STAR+PLUS), CHIP (CHIP, CHIP Perinate), Medicare and Duals (D-SNP, Medicare Advantage, Medicare Dual Aligned), and Commercial and Specialty lines (Preferred Administrators, HCO). Directly supervises Clinical Reviewers (RNs/LVNs) to ensure timely, accurate, and compliant coverage decisions, and provides oversight to Utilization Review Assistants who assist with workflows, reporting, and the completion of clerical duties related to authorizations.

Skills

• Excellent oral/written communication skills and exemplary interpersonal skills.
• Proficient in Microsoft Windows, Word, Excel, and PowerPoint with strong analytical, and data management skills.
• Proficient in utilization management principles, conflict resolution, creative problem-solving, and/or group facilitation techniques.
• Demonstrated knowledge of state regulations, compliance standards, and network guidelines; ability to interpret health plan benefits to community providers, manage clinical authorization workflows, and make accurate, data-driven medical necessity decisions.
• Ability to provide effective, professional support to teams, manage multiple priorities in a fast-paced environment, and oversee the productivity of utilization reviewers.
• Demonstrates sensitivity to cultural diversity and the ability to work with diverse populations; self-motivated, with a willingness to take responsibility for clinical care.
• Strong time management skills, with the ability to prioritize activities and complete assignments; ability to interact effectively with supervisors, members, and community providers.

Work Experience

One year of clinical supervisory, lead, or charge nurse experience is required. Experience with utilization review/utilization management within a managed care organization (MCO) environment is preferred. Deep operational knowledge of MCG and InterQual clinical guidelines, CMS regulations, Texas Medicaid rules, HHSC requirements, and TDI regulations is required.

License/Registration/Certification

Active andunrestricted license to practice as a Registered Nurse (RN) in the State of Texas is required.

Education and Training

Bachelor of Science in Nursing (BSN) is required.

1145 Westmoreland Drive
El Paso, TX 79925-5615