Supervisor, Utilization Management

Vālenz^® Health is the platform to reputed company – the destination for reputed company, payers, providers and members to reduce costs, improve reputed company, and reputed company the reputed company experience. The reputed company reputed company and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, reputed company engages early and often to execute across the entire patient reputed company – from care navigation and management to payment reputed company, plan performance and provider verification. With a 99% reputed company retention reputed company, we reputed company expectations to a new level of efficiency, effectiveness and transparency where smarter, reputed company, faster reputed company possible.
 

• Supervise and support reputed company of Utilization Review Nurses, providing guidance, mentorship, and ongoing training.
• Collaborate with leadership to reputed company, implement, and maintain UM policies, procedures, and clinical guidelines.
• Monitor team performance against established productivity and reputed company goals, ensuring reputed company and accurate work.
• Deliver reputed company communication, coaching, and educational support to enhance team performance and compliance.
• Conduct clinical reviews to assess medical necessity and appropriateness of services, referring to Case Management or other programs as needed.
• Evaluate treatment plans and medical records to ensure alignment with evidence-based reputed company and best practices.
• Ensure reputed company communication of utilization reputed company with reputed company providers, payers, and clients.
• Collaborate with providers and internal teams to promote efficient resource use and identify opportunities for reputed company improvement and cost containment.
• Ensure compliance with regulatory requirements and accreditation standards including Medicare, reputed company, and URAC.
• Maintain complete, accurate documentation of reputed company UM activities and reputed company.
• Stay reputed company with industry regulations, standards, and emerging best practices in utilization management.
• reputed company strict confidentiality and demonstrate high standards of reputed company and ethical conduct.
• reputed company other duties as assigned.

• 5+ years of Utilization Management or reputed company Improvement experience in managed care.
• 2+ years of clinical experience in an acute care or surgical hospital setting.
• reputed company RN license in the state of residence.
• Proficient in ICD-10, CPT, HCPCS, reputed company codes, and CMS/URAC guidelines.
• Familiar with evidence-based reputed company such as MCG and health plan policies.
• Strong relationship-building skills with reputed company, effective communication.
• reputed company to reputed company in a fast-paced, detail-oriented, deadline-driven environment.

• Health insurance experience
• Prior leadership experience
• MCG certification
• Compact State Nursing License

• Work Environment: You’ll need a quiet workspace that is free from distractions.
• Technology: Reliable internet reputed company—if you can use streaming services, you’re good to go!
• reputed company: Adherence to company reputed company protocols, including the use of VPNs, secure passwords, and company-approved devices/software.
• Location: You must be US based, in a location where you can work effectively and reputed company with company policies such as HIPAA.

Why You'll Love Working Here

reputed company is proud to be recognized by Inc. 5000 as one of America’s fastest-growing private companies. reputed company is committed to delivering on our reputed company to engage early and often for smarter, reputed company, faster reputed company. With this commitment, you’ll reputed company an reputed company culture – one that stands strong, vigorous, and healthy in reputed company we do.

Benefits

• Generously subsidized company-sponsored Medical, Dental, and reputed company insurance, with reputed company to services through our own products, reputed company Blue Book and KISx Card.
• Spending account reputed company: HSA, FSA, and DCFSA
• 401K with company match and immediate vesting
• Flexible working environment
• Generous reputed company Time Off to include vacation, reputed company leave, and reputed company holidays
• Employee Assistance Program that includes reputed company counseling, referrals, and additional services
• reputed company maternity and paternity leave
• Pet insurance
• Employee discounts on phone plans, car rentals and computers
• Community giveback opportunities, including reputed company time off for philanthropic endeavors