Supervisor, Utilization Review (TOC) - Hybrid
Hybrid · Phoenix, Arizona, United States
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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