Utilization Review Supervisor

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🏄 California – Remote

🏄 California – Remote

💵 $70k - $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Intercare Holdings Insurance Services

WebsiteLinkedInAll Job Openings

201 - 500 employees

Insurance • Risk Management

Intercare Holdings Insurance Services is a privately held company that specializes in workers' compensation and liability claims administration, managed care services, and risk management solutions. Known for their client care and responsive service, Intercare integrates advanced technology and has an in-house Special Investigations Unit (SIU) to handle claims efficiently and reduce fraudulent activities. Their unique approach combines the depth and capacity of a large organization with the flexibility of a smaller firm, ensuring customized risk management and cost control solutions for clients. With a strong emphasis on customer satisfaction, Intercare is a trusted partner in reducing risk and maintaining fiscal stability for their clients.

📋 Description

• Plans, assigns, and directs the work of the Utilization Review team for all InterMed offices, including day-to-day operational oversight. • Determines appropriate caseloads that allow for timeliness of requests and productivity that meets expectations. • Provides ongoing advice, mentoring, coaching, counseling, and performance feedback to assigned staff. • Completes performance reviews for all personnel within the assigned unit in a timely manner. • Deals quickly and decisively with personnel issues as they arise; keeps the supervisor informed on the need for, or progress of, corrective action. • Authorizes time-off requests to ensure coverage necessary to maintain service guidelines. • Performs weekly audits of more than 10% of reviews per UR Nurse to validate accuracy and completeness of the utilization review process, and conducts comparable periodic audits of Medical Management Coordinator work product. • Serves as InterMed's compliance officer, ensuring compliance with state and URAC regulations. • Participates as an active member of InterMed's Quality Management Program Committee, including quarterly meetings to discuss program improvements, measurements, assessments, and compliance. • Maintains awareness of potential compromise to a patient's safety on each review and refers concerns to the proper authority. • Requires comprehensive knowledge of Utilization Review guidelines in the California Labor Code and other states as needed. • Works with the Medical Director to ensure compliance with Utilization Review guidelines. • Oversees training of new staff on computer systems and on UR policies and procedures. • Provides training for Intercare claims team at various locations to ensure timely and accurate workflow. • Exhibits a knowledgeable and helpful attitude and projects a professional image on behalf of InterMed and Intercare. • Fosters teamwork and cooperation between UR staff and other departments at InterMed, Intercare, and client organizations. • Notifies the supervisor of potential client issues and works toward resolution. • Assists with the implementation of new accounts, with input from account management, and supports staff compliance with client service instructions. • Works effectively with peers across departments, demonstrating professionalism, respect, and a team-oriented approach. • Uses plain language to communicate, in writing and verbally, with injured workers, claims examiners, and clients. • Maintains production performance and savings reports for management review. • Leverages AI and office productivity tools to support project management and reporting workflows. • Handles other duties and tasks as assigned by leadership.

🎯 Requirements

• Minimum of three years of clinical experience. • Minimum of three years of leadership or supervisory experience. • Minimum of one year of California Workers' Compensation Utilization Review experience, including working knowledge of the California Workers' Compensation Labor Code and regulations, and other states as needed. • Progressive technical experience demonstrating sound judgment and discretion, with the ability to provide guidance on complex cases. • Current, unrestricted RN or LVN license in the state in which the employee resides.

🏖️ Benefits

• Comprehensive medical, dental, and vision benefits • Company contributions to HSA and FSA plans • Employer-paid life and disability insurance • 401(k) with company match • Paid time off (PTO) and company-paid holidays • Learning and development opportunities that support real career advancement • Employee assistance resources and a supportive culture that values balance and wellbeing