Position Summary
As a key leader within the Utilization Review Services, this role is responsible for assisting and supervising a multidisciplinary team with the day-to-day management of the Utilization Review Services and team members.

This position will involve coordinating staff schedules to efficiently handle incoming referrals and phone call volumes and assist in the development of workflows, procedures, protocols, and best practices to achieve organizational goals and objectives.

This position involves researching and resolving simple and complex patient/provider issues related to authorization, denials, clinical reviews and collaboration with physician advisors.

This position will also conduct performance evaluations, counsel employees, and take disciplinary action as necessary in collaboration with the manager and director. The Supervisor will also participate in provision of service delivery during a portion of the time and assist with overall operations of the service.

This position is a hybrid onsite/virtual role and will involve travel within the ECU Health service area.
Responsibilities
Manage team responsible for completing utilization management programs, processes, and tasks.

Edit, maintain, and implement policies and procedures that meet applicable regulatory requirements and business needs.

Implement and facilitate curriculum and ongoing training in collaboration with education specialists.

Maintain daily case management statistics and reporting.

Research and manage team member and patient complaints.
Minimum Requirements
Bachelor of Science or higher in Nursing is required.

Master of Science in Nursing is preferred.

Two or more years' experience in Utilization Review required.

Experience with evidence based clinical guidelines including MCG (Miliman) and/or InterQual preferred.
Pay Range
$79664.00 - $116116.00
Other Information
Hybrid - weekdays - call on weekends rotating.