Job Description

A bit about this role:

The Post-Acute UM Supervisor will oversee utilization management activities across post-acute settings (SNF, ARU, LTACH), including audits, quality reviews, and clinical oversight. This role will partner with medical leadership to implement education, workflow refinements, and policy updates aligned with InterQual, CMS guidelines, and internal clinical criteria.

The supervisor will also collaborate closely with clinical, operational, and technology teams to design, implement, and optimize AI/LLM-enabled workflows that support prior authorization review, concurrent review, documentation quality, and care transition efficiency. This includes identifying opportunities to reduce administrative burden while improving consistency, accuracy, and turnaround time.

This is a fast-paced, high-change environment requiring strong operational leadership, adaptability, and the ability to manage multiple priorities while guiding a team through ongoing transformation.

Your Responsibilities and Impact will include:

• Supervise the Post-Acute UM team, including hiring, scheduling, training, performance management, coaching, and corrective action

• Monitor and act on key UM and operational metrics (timeliness, approval/denial trends, readmissions, length of stay, throughput), identifying patterns and driving performance improvement

• Support consistent application of InterQual criteria and CMS/Medicare Advantage guidelines across post-acute review decisions

• Lead quality audits and ensure documentation integrity and compliance with regulatory and health plan standards

• Partner with clinical leadership and IT/analytics teams to implement and enhance AI/LLM-supported workflows (e.g., clinical summarization, decision support, documentation assistance, and queue prioritization)

• Drive workflow standardization and identify automation opportunities to improve efficiency and staff experience

• Support education and onboarding for new and existing staff on post-acute UM processes and tools

Required skills and experience:

• Active unrestricted RN license with a minimum of 4 years of clinical experience

• At least 3 years of utilization management experience within a health plan or managed care setting

• At least 1–2 years of supervisory or team lead experience

• Working understanding of AI/LLM tools and their application in clinical or UM workflows

• Knowledge of InterQual criteria and/or other evidence-based medical necessity guidelines

• Understanding of CMS regulations and Medicare Advantage requirements

Desired skills and experience:

• Certification or formal training in InterQual

• Experience working in post-acute care utilization management (SNF, ARU, LTACH)

• Experience participating in or leading AI/automation or digital transformation initiatives within UM or care management environments

#LI-Remote

Salary Ragne: $95,000-$120,000

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.