Supervisor, Acute & Post-Acute Utilization Management

Medical Mutual•Cleveland, OH

2d•Hybrid

About The Position

The Supervisor, Acute & Post-Acute Utilization Management supervises assigned utilization staff and ensures they appropriately apply medical necessity guidelines when making authorization determinations for inpatient admissions, concurrent reviews, and retrospective reviews in collaboration with physician reviewers. The role oversees processes that support evidence-based discharge planning, helping ensure patients transition safely and promptly to the next level of care. The supervisor leads the team’s daily operations, supports staff onboarding and development, and works to improve retention, efficiency, quality, and employee engagement. The role collaborates across disciplines and with providers, partners, vendors, and subcontractors to support utilization management and discharge planning. It also monitors data accuracy, authorization timeliness, reports, and internal controls, while ensuring compliance with company policies, regulations, and accreditation standards. This is a hybrid position in Brooklyn, Ohio, requiring three onsite days per week. Medical Mutual provides the equipment needed for the role, including a laptop, monitors, keyboard, mouse, and headset.

Requirements

Graduate of a registered nursing program approved by the Ohio State Nursing Board.
Seven or more years of progressive experience as a Registered Nurse in health insurance utilization review or case management, or equivalent relevant RN experience in clinical practice.
Relevant experience leading teams or projects.
Current unrestricted Ohio Registered Nurse license.
Intermediate proficiency in Microsoft Office and web-based applications.
Knowledge of healthcare delivery systems, managed care operations, health insurance benefits, and network design.
Knowledge of medical terminology, coding, and claims management, including ICD-10, CPT, and HCPCS.
Knowledge of HIPAA and applicable regulatory requirements.
Knowledge of patient care continuums, expected outcomes, and community-based resources.
Ability to analyze data, identify root causes, and apply continuous process improvement methodologies.
Ability to manage multiple priorities, solve complex problems, and adapt in a fast-paced environment.
Ability to lead teams and facilitate change.

Nice To Haves

Bachelor of Science in Nursing or Healthcare Administration.
Lean Six Sigma Yellow Belt certification.
Knowledge of Lean Six Sigma principles.

Responsibilities

Supervise the daily operations of assigned utilization staff.
Provide leadership and change management to improve retention, efficiency, and quality outcomes.
Promote a transparent, high-performance culture through clear goals, performance feedback, and effective communication.
Facilitate interdisciplinary collaboration for utilization management and discharge planning.
Support staff onboarding, training, coaching, and professional development.
Apply evidence-based criteria and standards to utilization management and discharge planning.
Ensure utilization staff gather the required data and information to enter authorizations.
Track, trend, and monitor data accuracy and the timeliness of authorization decisions.
Monitor designated reports to ensure internal controls are effective.
Develop solutions that support departmental goals.
Evaluate individual and team performance against established targets and motivate staff to meet utilization, cost, quality, and productivity goals.
Be accountable for team results and employee engagement as measured by employment surveys.
Assist the Manager in coordinating and facilitating system processes with providers, partners, vendors, and subcontractors as needed.
Ensure compliance with company policies and procedures, state and federal rules and regulations, and accreditation standards.
Perform other duties as assigned.

Benefits

Employee bonus program.
401(k) with company match up to 4% and an additional company contribution.
Health Savings Account with a company matching contribution.
Medical, dental, vision, life, and disability insurance.
Employee Assistance Program with professional counseling, personal and professional coaching, self-help resources, and work/life benefits assistance.
Company holidays and up to 16 PTO days during the first year, with options to carry over unused PTO.
Parental leave after 120 days of service for eligible employees who become parents through maternity, paternity, or adoption.
Career development programs and classes.
Mentoring and coaching.
Tuition reimbursement up to $5,250 per year.
On-site fitness centers at many locations or gym membership reimbursement where a Medical Mutual facility is unavailable.
On-site cafeteria at the Brooklyn, Ohio headquarters.
Discounts at participating places in and around town.
Opportunity to earn cash rewards for shopping with Medical Mutual customers.
Business casual attire, including jeans.
Business Resource Groups and a diverse, inclusive, and welcoming culture.
Equipment needed for the role, including a laptop, monitors, keyboard, mouse, and headset.