Supervisor, Utilization Management (Healthcare)

Location: Remote-AZ; US citizenship is required for Health Net Federal Services roles

Salary: $75,300–$135,400 per year

Company

hirify.global provides healthcare services focused on connecting people and communities with needed care.

What you will do

• Supervise prior authorization, concurrent review, and retrospective clinical review activities.
• Monitor utilization management resources and performance against compliance, quality, and efficiency standards.
• Collaborate with clinical teams, members, providers, and senior management to resolve complex care issues.
• Develop and implement utilization management policies, procedures, and clinical guidelines.
• Coach team members, provide performance feedback, and support onboarding, hiring, and training.
• Lead quality, process, and change-improvement initiatives within utilization management.

Requirements

• Graduate of an accredited school of nursing or a bachelor's degree.
• 4+ years of related experience.
• Registered Nurse license through state licensure and/or compact state licensure.
• For Health Net Federal Services, current active licensure or certification permitting independent assessment is required.
• For Health Net Federal Services Medical Management, Certified Managed Care Nurse certification is required within 1.5 years.
• For Health Net Federal Services, US citizenship and a current National Agency Check government security clearance are required.

Nice to have

• Knowledge of utilization management principles.

Culture & Benefits

• Health insurance and comprehensive employee benefits.
• 401(k) and stock purchase plans.
• Tuition reimbursement.
• Paid time off and holidays.
• Flexible remote, hybrid, field, or office work schedules.