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RN Supervisor of Utilization Review

Washington, DC · Healthcare
RN Supervisor of Utilization Review – Managed Care
Washington D.C. (near Metro Center)
Supervisor of Utilization Review Job Summary:
  • Supervises clinical and non-clinical operations, ensuring fulfillment of all required contractual, legal, and accreditation standards plus compliance with corporate and Care Management policies. 
  • Supervises (and assists) staff that conducts case management, prior authorization reviews, pre-admission reviews, emergency admission reviews, continued stay reviews, retrospective reviews, and long-term care reviews.
  • Contributes to, implements, and maintains departmental policies and procedures, staffing protocols, and training programs.
  • Supervises continuous quality improvement initiatives to improve the delivery, quality, and effectiveness of service delivery.
  • Monitors the reliability and consistency of teams' work output to ensure adherence to contract deliverables; collaborates with the Project Director to effectively address issues that are identified.
  • Attends monthly performance meetings with the contracting officer’s representative; provides feedback on the findings of the monitoring activities, identifies opportunities for performance improvement, and steps that must be taken to implement initiatives or complete corrective action.
  • Will also conduct utilization management reviews, plus other case reviews. 
Supervisor of Utilization Review Background:
  • Valid, unrestricted state Registered Nurse (R.N.) license.
  • Prefer Bachelor of Science or Arts in healthcare related field; Master’s degree a plus.
  • Certified Professional in Healthcare Quality (CPHQ) or Utilization (CPHM/CPUR/CPUM) is preferred.
  • Around 5 years of acute care clinical nursing experience required.
  • Requires 2-3 years of Medicaid-specific Utilization Management & Quality Improvement experience.
  • Requires proficiency with utilization review, community-based programs, quality improvement, and Medicaid.
  • Around 1 year of progressive staff supervision experience as lead or supervisor within a healthcare environment.
  • Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.
  • Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously. 


443.470.8240 (CALL – TEXT – FAX)
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