Supervisor, Utilization Management Support

Job DescriptionA 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 r...