Intercare Holdings Insurance Services logo
Intercare Holdings Insurance Services

Extraordinary People. Extraordinary Results.

Utilization Review Supervisor

Location

California

Posted

9 days ago

Salary

$70K - $90K / year

Seniority

Senior

Bachelor Degree3 yrs expEnglish

Job Description

Utilization Review Supervisor

Intercare Holdings Insurance Services

• Plans, assigns, and directs the work of the Utilization Review team for all InterMed offices, including day-to-day operational oversight. • Determines appropriate caseloads that allow for timeliness of requests and productivity that meets expectations. • Provides ongoing advice, mentoring, coaching, counseling, and performance feedback to assigned staff. • Completes performance reviews for all personnel within the assigned unit in a timely manner. • Deals quickly and decisively with personnel issues as they arise; keeps the supervisor informed on the need for, or progress of, corrective action. • Authorizes time-off requests to ensure coverage necessary to maintain service guidelines. • Performs weekly audits of more than 10% of reviews per UR Nurse to validate accuracy and completeness of the utilization review process, and conducts comparable periodic audits of Medical Management Coordinator work product. • Serves as InterMed's compliance officer, ensuring compliance with state and URAC regulations. • Participates as an active member of InterMed's Quality Management Program Committee, including quarterly meetings to discuss program improvements, measurements, assessments, and compliance. • Maintains awareness of potential compromise to a patient's safety on each review and refers concerns to the proper authority. • Requires comprehensive knowledge of Utilization Review guidelines in the California Labor Code and other states as needed. • Works with the Medical Director to ensure compliance with Utilization Review guidelines. • Oversees training of new staff on computer systems and on UR policies and procedures. • Provides training for Intercare claims team at various locations to ensure timely and accurate workflow. • Exhibits a knowledgeable and helpful attitude and projects a professional image on behalf of InterMed and Intercare. • Fosters teamwork and cooperation between UR staff and other departments at InterMed, Intercare, and client organizations. • Notifies the supervisor of potential client issues and works toward resolution. • Assists with the implementation of new accounts, with input from account management, and supports staff compliance with client service instructions. • Works effectively with peers across departments, demonstrating professionalism, respect, and a team-oriented approach. • Uses plain language to communicate, in writing and verbally, with injured workers, claims examiners, and clients. • Maintains production performance and savings reports for management review. • Leverages AI and office productivity tools to support project management and reporting workflows. • Handles other duties and tasks as assigned by leadership.

Job Requirements

  • Minimum of three years of clinical experience.
  • Minimum of three years of leadership or supervisory experience.
  • Minimum of one year of California Workers' Compensation Utilization Review experience, including working knowledge of the California Workers' Compensation Labor Code and regulations, and other states as needed.
  • Progressive technical experience demonstrating sound judgment and discretion, with the ability to provide guidance on complex cases.
  • Current, unrestricted RN or LVN license in the state in which the employee resides.

Benefits

  • Comprehensive medical, dental, and vision benefits
  • Company contributions to HSA and FSA plans
  • Employer-paid life and disability insurance
  • 401(k) with company match
  • Paid time off (PTO) and company-paid holidays
  • Learning and development opportunities that support real career advancement
  • Employee assistance resources and a supportive culture that values balance and wellbeing

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