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Supervisor, Utilization Management
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- Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members.
- Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
- Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures
- Assists with onboarding, hiring, and training utilization management team members
- For Health Net Federal Services: Must have current and active licensure or certification that permits independent assessment required
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