Utilization Review Supervisor — RN Lead & Compliance

BBSS Beyond Blue; Kentucky; Hybrid; GBP 45,000 - 60,000; Full time

Job summary

Beyond Blue is seeking a Supervisor, Utilization Review to lead the daily operations of the utilization review team in the UK. The role ensures compliance with payer guidelines and regulatory standards while guiding staff performance and quality assurance.

Responsibilities include coordinating with physicians, payers, and interdisciplinary teams to optimize patient care and reimbursement, delivering timely authorization determinations, and contributing to policy development.

Qualifications

• High School diploma or equivalent required.
• RN license required.
• 0–4 years of related experience in RN or Utilization Review; paid experience only.

Responsibilities

• Supervises daily activities of utilization review staff, including scheduling, assignments, and workload distribution.
• Reviews and monitors utilization review cases for accuracy and compliance with payer and regulatory requirements.
• Provides coaching, training, and performance feedback to staff.
• Develops and implements quality assurance to ensure medical necessity criteria and standards.
• Collaborates with physicians, case managers, and payers to resolve complex authorization issues.
• Prepares and presents utilization review reports and metrics to management.
• Assists in policy and procedure development to support compliance and efficiency.
• Stays current with industry regulations, payer policies, and accreditation standards.
• Liaises between clinical departments, payers, and leadership to resolve escalated issues.
• Performs other duties as assigned.

Skills

Supervision

Regulatory compliance

Utilization review

Interdisciplinary collaboration

Education

High School diploma or equivalent

Job description

Beyond Blue is seeking a Supervisor, Utilization Review to lead the daily operations of the utilization review team in the UK. The role ensures compliance with payer guidelines and regulatory standards while guiding staff performance and quality assurance.

Responsibilities include coordinating with physicians, payers, and interdisciplinary teams to optimize patient care and reimbursement, delivering timely authorization determinations, and contributing to policy development.