Role OverviewThe Clinical Care Coordination Supervisor oversees daily operations of the UM team, ensuring compliance with regulatory standards, organizational policies, and industry best practices. This role supports staff development, monitors performance, and promotes high-quality, cost-effective care coordination.
What You Will Do
The role ensures compliance with utilization management (UM) processes, evaluates eligibility for benefit coverage, and collaborates with internal and external stakeholders to optimize patient care.
Why It Might Be a Fit
This position requires a strong understanding of utilization management, medical necessity criteria, and regulatory compliance, as well as excellent leadership, problem-solving, and decision-making abilities.
Requirements
- Bachelor's degree in Nursing (BSN, Healthcare Administration, or a related field
- Minimum of 3–5 years of experience in utilization management, case management, or a related healthcare setting
- At least 2 years of leadership or supervisory experience in a healthcare environment
- Strong understanding of utilization management, medical necessity criteria, and regulatory compliance (e.g., CMS, NCQA, URAC)
- Proficient in Microsoft products (Word, Excel, Powerpoint)
- Excellent leadership, problem-solving, and decision-making abilities
- Strong communication and interpersonal skills for cross-functional collaboration
Benefits
- Medical, Vision, Dental, Short- and Long-term insurance
- 6+ Days of Holidays Pay
- 13 days of PTO
- Employer paid life insurance
- 401K with employer contribution
- Wellness program with reward incentives
- Employee recognition and reward programs
- Comprehensive paid training program
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