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Blue Cross Blue Shield of Michigan1 week ago

Supervisor, Utilization Review (TOC) - Hybrid

Hybrid · Phoenix, Arizona, United States

Type
Full Time
Level
Mid Level
Education
Associates Degree
Company size
Enterprise

Job Summary

Supervisor in Utilization Review responsible for coordinating UR activities related to medical necessity reviews and authorizations for inpatient, observation, and sub-acute care for Medicaid members. Oversees Transition of Care post-discharge, monitors timeliness, cost-effectiveness, and regulatory standards, and ensures audits, reporting, debt-to-budget adherence, and staff performance coaching. Requires InterQual usage, leadership of the UR team, and onsite presence in AZ with hybrid options (onsite minimums vary by role).

Required Qualifications

  • 2 years of direct clinical experience
  • 1 year of experience in utilization review
  • Associate’s Degree in Nursing
  • Active, current, and unrestricted RN license in the State of Arizona
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Blue Cross Blue Shield of Michigan

Supervisor, Utilization Review (TOC) - Hybrid

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