Utilization Management Nurse Supervisor

• Provide day-to-day supervision of UM nurses, ensuring productivity, accuracy, and adherence to policies and processes.
• Conduct regular 1:1s, coaching sessions, and performance evaluations to support staff growth and accountability.
• Lead daily/weekly huddles, communicate priorities, and set expectations for performance and timeliness.
• Serve as first point of escalation for staff questions, operational challenges, or case-related concerns.
• Promote a culture of collaboration, accountability, and continuous improvement.
• Monitor team productivity, timeliness, and quality of work through reporting and audits.
• Take accountability for overall team performance, escalating issues as needed to the UM Clinical Manager.
• Ensure compliance with all regulatory, contractual, and accreditation standards (CMS, NCQA, state-specific requirements).
• Support audit preparation, quality initiatives, and corrective action plans as needed.
• Oversee case assignment, queue management, and authorization workflows to ensure timely completion.
• Perform authorization reviews as needed, utilizing federal/state mandates, plan benefit language, and medical necessity criteria (e.g., InterQual, CMS, health plan policies).
• Review and process clinical and administrative appeals; coordinate with Medical Director when required.
• Generate and review daily/weekly reporting on productivity and case timeliness.
• Manage team calendars, including PTO, planned outages, and rotation schedules.
• Participate in user acceptance testing (UAT), system/process improvements, and special projects.
• Act as liaison between UM staff and UM leadership to ensure clear communication of priorities, policies, and workflow changes.
• Collaborate with internal partners (e.g., Provider Relations, Quality) to resolve escalations and address utilization management issues.
• Represent UM nursing team in internal meetings and external stakeholder interactions as directed.
• Remote work environment with expectations for timely communication and responsiveness.
• Must be able to handle confidential and sensitive information in compliance with company policies and regulations.
• Flexibility to adapt to changing priorities, systems, and workflows in a fast-paced environment.

• Minimum 3 years of nursing experience in acute, outpatient, or managed care setting.
• Minimum 2 years of utilization management experience in a payer or managed care environment.
• Strong understanding of utilization review, authorizations, and appeals processes.
• Excellent verbal/written communication and organizational skills.
• Experience with Medicare and Medicaid requirements.
• Familiarity with DMEPOS authorization and appeals processes.
• Knowledge of medical necessity criteria (InterQual, CMS, health plan policies).
• Prior leadership, supervisory, or team lead experience in a UM setting.

• Competitive compensation and annual bonus program
• 401(k) retirement program with company match
• Company-paid life insurance
• Company-paid short term disability coverage (location restrictions may apply)
• Medical, Vision, and Dental benefits
• Paid Time Off (PTO)
• Paid Parental Leave
• Sick Time
• Paid company holidays and floating holidays
• Quarterly company-sponsored events
• Health and wellness programs
• Career development opportunities

Integra Partners