利用管理护士主管

The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team performance, accountability, and professional development by conducting regular 1:1s, managing performance reviews, and driving compliance with organizational, state, and federal requirements. The Supervisor balances hands-on operational responsibilities with leadership duties, serving as both a mentor and performance manager for frontline staff.

Salary: $75,000.00/Annually

JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES

The UM Nurse Team Lead’s responsibilities include but are not limited to:

• Provide day-to-day supervision of UM nurses, ensuring productivity, accuracy, and adherence to policies and processes.

• Conduct regular 1:1s, coaching sessions, and performance evaluations to support staff growth and accountability.

• Lead daily/weekly huddles, communicate priorities, and set expectations for performance and timeliness.

• Serve as first point of escalation for staff questions, operational challenges, or case-related concerns.

• Promote a culture of collaboration, accountability, and continuous improvement.

• Monitor team productivity, timeliness, and quality of work through reporting and audits.

• Take accountability for overall team performance, escalating issues as needed to the UM Clinical Manager.

• Ensure compliance with all regulatory, contractual, and accreditation standards (CMS, NCQA, state-specific requirements).

• Support audit preparation, quality initiatives, and corrective action plans as needed.

• Oversee case assignment, queue management, and authorization workflows to ensure timely completion.

• Perform authorization reviews as needed, utilizing federal/state mandates, plan benefit language, and medical necessity criteria (e.g., InterQual, CMS, health plan policies).

• Review and process clinical and administrative appeals; coordinate with Medical Director when required.

• Generate and review daily/weekly reporting on productivity and case timeliness.

• Manage team calendars, including PTO, planned outages, and rotation schedules.

• Participate in user acceptance testing (UAT), system/process improvements, and special projects.

• Act as liaison between UM staff and UM leadership to ensure clear communication of priorities, policies, and workflow changes.

• Collaborate with internal partners (e.g., Provider Relations, Quality) to resolve escalations and address utilization management issues.

• Represent UM nursing team in internal meetings and external stakeholder interactions as directed.

• Remote work environment with expectations for timely communication and responsiveness.

• Must be able to handle confidential and sensitive information in compliance with company policies and regulations.

• Flexibility to adapt to changing priorities, systems, and workflows in a fast-paced environment.

EDUCATION: Active, unrestricted Registered Nurse, Licensed Vocational Nurse, or Licensed Practical Nurse license

EXPERIENCE:
· Minimum 3 years of nursing experience in acute, outpatient, or managed care setting.

• Minimum 2 years of utilization management experience in a payer or managed care environment.

• Strong understanding of utilization review, authorizations, and appeals processes.

• Excellent verbal/written communication and organizational skills.

• Experience with Medicare and Medicaid requirements.

• Familiarity with DMEPOS authorization and appeals processes.

• Knowledge of medical necessity criteria (InterQual, CMS, health plan policies).

• Prior leadership, supervisory, or team lead experience in a UM setting.

Benefits Offered

• Competitive compensation and annual bonus program

• 401(k) retirement program with company match

• Company-paid life insurance

• Company-paid short term disability coverage (location restrictions may apply)

• Medical, Vision, and Dental benefits

• Paid Time Off (PTO)

• Paid Parental Leave

• Sick Time

• Paid company holidays and floating holidays

• Quarterly company-sponsored events

• Health and wellness programs

• Career development opportunities

Remote Opportunities
We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.
Our Story
Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits.
With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.
Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.
Originally posted on Himalayas