The Utilization Review Supervisor is responsible for the technical and clinical supervision of the Utilization Review department under the direction of the Director of Case Management.
The Utilization Review Supervisor will assist in planning, organizing and assist with supervising the unit staff, preparing the department for internal and external audits, and developing policies and procedures for adherence to government and accredited agency standards.
The Utilization Review Supervisor will oversee and participate in the development and implementation of effective and efficient standards, policies, protocols and reports that support and enhance utilization management and delivery of care.
EDUCATION: Graduate of an accredited program for Registered Nursing.
CERTIFICATION/LICENSES: RN with current New Mexico licensure
SKILLS: Strong leadership skills and previous supervisory experience including experience in facilitating interdisciplinary team collaboration. Evidence of such experience should include:
- Strong nursing knowledge and clinical skills
- Effective communication skills (verbal and written)
- Strong analytical skills
- Ability to problem solve; ability to appropriately confront issues
- Ability to motivate others as individuals and as a team
- Ability to plan, organize, and manage the activities of others under the supervision of the Case management director
- Ability to effectively run meetings and to negotiate deadlines.
- Ability to communicate with a wide variety of audiences
- Experience in dealing with physicians and able to work collaboratively with medical staff members and leadership.
EXPERIENCE: Minimum of 5 years of case management experience, with emphasis on Utilization management. Supervisory experience preferred.
-Responsible to: Director of Case Management
Subject to stressful professional relationships. Working hours vary, with flexibility due to unexpected changes in schedule and emergencies. Requires the ability to speak, listen, develop and communicate written materials.