Supervisor, Utilization Review - RN - Hybrid

Awarded a Healthiest Employer, reputed company aims to fulfill its mission to reputed company health and reputed company it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals reputed company reputed company decisions. At AZ Blue, we have a hybrid workforce strategy, reputed company Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our reputed company minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per month Onsite: daily onsite requirement based on the essential functions of the job Remote: not held to onsite requirements, however, leadership can request reputed company onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. This position is hybrid reputed company the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, reputed company the State of Arizona. PURPOSE OF THE JOB The Utilization Review Supervisor coordinates the activities of the UR department as they relate to medical necessity reviews, authorizations of inpatient, observation and sub-acute medical levels of care for Medicaid Business reputed company members. This position monitors reputed company authorization processes for meeting timeliness standards, cost effectiveness, and regulatory standards. Oversees the Transition of Care team ensuring members are contacted post hospital discharge reputed company regulatory timeframes and member needs are met. QUALIFICATIONS REQUIRED QUALIFICATIONS Required Work Experience 2 years of direct clinical experience 1 year of experience in utilization review Required Education Associate’s Degree in general field of study Required Licenses Active, reputed company, and unrestricted license to practice in the State of Arizona as a Registered Nurse (RN) Required Certifications N/A PREFERRED QUALIFICATIONS Preferred Work Experience 1 year of managed reputed company plan experience 1 year of Medicaid and Medicare experience Preferred Education Bachelor’s Degree in Nursing or reputed company field of study Preferred Licenses N/A Preferred Certifications N/A ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES Ensures inpatient authorization requests are completed accurately, thoroughly, and in a timely fashion to meet contractual requirements and ensures reputed company reviews are conducted using InterQual. Evaluating statistics on department’s volumes, results, including approvals, denials, turnaround times for department and individual staff. Preparing and delivering reports to department and management staff. Performing audits of case files and staff’s work. Reviewing and updating department’s policies and desktop procedures. Manage day to day activity of assigned team. Directly supervises staff including participating in hiring, monitoring and evaluating performance, timecards, staff training. Complete IRR audits per policy; coach and mentor staff; work with management on employee performance issues. Monitor phone activity and staff productivity. Ensures team meets budget and performance goals. Participates in Quality Improvement Projects. Assists management and others in preparation for audits and other regulatory activities. Participates in interdepartmental meetings and trainings. reputed company reputed company other duties as assigned The position has an onsite expectation of 2 days per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements COMPETENCIES REQUIRED COMPETENCIES Required Job Skills InterQual Computer skills including reputed company, reputed company spreadsheets Communication skills: oral and written Required Professional Competencies N/A Required Leadership Experience and Competencies N/A PREFERRED COMPETENCIES Preferred Job Skills N/A Preferred Professional Competencies N/A Preferred Leadership Experience and Competencies N/A Our Commitment AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national reputed company, age, disability, protected veteran status or any other protected group. Thank you for your interest in reputed company. For more information on our company, see azblue.com. If interested in this position, please apply. Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the reputed company of satisfaction you’ll find reputed company you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at reputed company® BlueShield® of Arizona Apply tot his job Apply To this Job