Supervisor, Credentialing/UM (Hybrid in San Diego)

UnitedHealth Group • San Diego, CA

92d • $48,700 - $87,000 • Onsite

About The Position

The Supervisor, Credentialing/UM is a dual-function leadership role responsible for overseeing both provider credentialing operations and utilization management (UM) processes. This position ensures compliance with regulatory standards, supports efficient workflows, and provides mentorship and oversight to staff handling prior authorizations, provider records, and credentialing documentation.

Requirements

• High School Diploma/GED (or higher).
• 1+ years of experience in healthcare operations, including credentialing and utilization management.
• 1+ years in a supervisory role.
• Experience in a managed care or healthcare setting.
• Experience with prior authorization processes and compliance audits.
• Proficiency in medical terminology, credentialing software, and Microsoft Office.
• Proven solid leadership, organizational, and problem-solving skills.
• Proven to utilize solid verbal and written communication skills.

Nice To Haves

• Certification as CPCS or CPMSM.
• ICD/CPT coding.
• Supervisory experience in a managed care setting.

Responsibilities

• Lead and manage a team of Credentialing Coordinators and UM Representatives.
• Assign tasks, monitor performance, and provide coaching and mentorship.
• Develop and implement best practices across credentialing and UM workflows.
• Facilitate training and support for new hires and ongoing staff development.
• Oversee daily processing of prior authorization requests to meet turnaround time standards.
• Coordinate with health plans for benefit interpretation and policy clarification.
• Support clinical staff by facilitating communication with physician offices and managing referrals.
• Ensure accurate data entry and document distribution (e.g., fax sorting).
• Serve as escalation point for complex service requests and member/provider inquiries.
• Manage credentialing and re-credentialing of healthcare providers in accordance with NCQA, CMS, and health plan standards.
• Maintain accurate provider records and credentialing databases.
• Lead compliance efforts, including reporting and adherence to state and federal regulations.
• Conduct audits and quality checks, including annual NCQA integrity audit analysis.
• Act as primary contact for credentialing and UM inquiries from internal teams, providers, and external agencies.
• Collaborate with health plans and internal departments to ensure seamless operations.
• Prepare and present reports on credentialing status, UM metrics, and compliance outcomes.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED