Supervisor, Utilization Management Support

Job Description

A bit about this role:

The Supervisor manages the day-to-day operations of the Utilization Management Coordinators, ensuring timely and accurate processing of prior authorization requests. This role is highly hands-on, focusing on daily execution, immediate problem-solving, staff coaching, and maintaining compliance with all regulatory requirements.

Your Responsibilities and Impact will include:

• Team Leadership & Development: Lead, coach, and develop staff, mentoring them on their competencies and career goals while monitoring productivity, accuracy, and performance; Provide operational and administrative support to the team.

• Intake & Prior Authorization Oversight: Directly manage daily operations of the Utilization Management Coordinator Team to ensure timely and accurate processing of authorization requests, including triaging and entering incoming PA requests and reaching out to hospitals and provider offices to obtain important clinical documentation; Ensure requests are appropriately entered, documented, and routed for clinical review and determination.

• Clinical Coordination Management: Oversee the coordination of clinical reviews and peer-to-peer (P2P) scheduling between providers and Medical Directors, including contacting providers to communicate clinical decisions; Ensure all required documentation is present for clinical review, including managing RFI work and EHR access workflows.

• Operational Performance & Compliance: Plan, organize, and coordinate the team's work and initiatives to ensure achievement of specific, measurable goals and deadlines, including meeting service level agreements and regulatory turnaround time requirements; Monitor work queues, daily census checks, and operational metrics; Identify obstacles, problem-solve, and implement changes to enhance workflow efficiency and ensure compliance with CMS, Medicare Advantage, and internal UM policies and procedures.

• AI Workflow Ownership: Act as the domain owner for Utilization Management AI workflows for the team, responsible for the full lifecycle, including building, executing, implementing, and monitoring the performance and refinement of AI/LLM-enabled tools; Define and track quality metrics (accuracy, throughput) for AI-enabled processes, interpreting data and making iteration decisions in partnership with AI Enablement Partners ; Ensure local governance and adherence to AI use policies within the team.

• Cross-Functional Collaboration: Cultivate and maintain strong partnerships with clinical leadership, provider relations, claims, and other internal teams to support seamless UM operations, including care transition workflows and case follow-up.

Required skills and experience:

• 3+ years of utilization management or prior authorization experience.

• 1+ year of prior leadership or supervisory experience required.

• Experience in Medicare Advantage or managed care.

• Knowledge of prior authorization workflows, clinical review processes, and regulatory requirements (e.g., Medicare Advantage).

• Strong organizational, communication, and operational management skills.

• Excellent problem-solving and analytical skills.

• Experience in a fast-paced, high-volume environment.

• Proficiency with healthcare systems, EHRs, and reporting tools.

• Experience driving technology-enabled workflow improvements, particularly with AI/LLM tools.

Desired skills and experience:

• Bachelor’s degree in healthcare operations, business administration, or a related field preferred.

• Experience with Intake, authorization, or clinical coordination processes.

• Familiarity with UM or case management workflows.

#LI-Remote

Salary range: $58,000 - $80,000 annually

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

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