Imagine360 · 1 day ago
Supervisor, Utilization Management
United States
Full-time
Remote
Mid, Senior Level
3+ years expImagine360 is a health plan solution company seeking a Supervisor, Utilization Management to oversee the Utilization Management Nurses and associated programs. The role involves managing team activities, implementing policies, and ensuring quality improvement in service delivery.
Health CareHealth InsuranceInsurance
Responsibilities
Collaborate with Senior Manager, Patient Review & Intake Services or Manager, Utilization Management to:
Manage team responsible for completing utilization management programs, processes, and tasks
Edit, maintain, and implement policies & procedures that meet applicable regulatory, accreditation, and business needs
Implement orientation curriculum and ongoing training and educational needs
Coordinate and supervise daily employee activities through supervision of the UM team
Maintain daily case assignment statistics and reporting for metrics
Manage and coordinate daily & weekly staffing needs and schedules based on the business
Review and manage approvals and communications for PTO requests by employees, as directed by the Manager or Senior Manager
Conduct performance evaluations and performance improvement plans for team
Conduct monthly 1:1 coaching sessions with UM Nurses, BR Nurses, and Lead Nurses
Lead bi-monthly UM Nurse and Benefit Review Nurse meetings
Lead the interviewing and hiring processes as needed
Research member complaints and issue resolutions
Lead projects and employee discussions that promote improvement in the delivery of services within the department
Collaborate with Quality Management programs by assisting in the quality assurance review and chart audit processes for UM employees
Perform monthly call and chart audits for the UM Nurses, BR Nurses, and Lead Nurses
Review QA results to develop educational opportunities for the UM employees and completes performance improvement plans for scores <90% per policies and procedures
Review policies and procedures as required and recommends changes to the Manager and Senior Manager
Collect, analyze, and report data of quality improvement projects and other data related to utilization services and benefit review services
Assist Supervisor, MIS with triaging of cases and monitoring call que as needed
Escalate high priority, high risk cases or staffing issues appropriately to Manager or Senior Manager
Perform UM tasks as staffing levels dictate
Communicate effectively with members, employees, healthcare providers, vendors, peers, and customers
Act as role model within a team setting to provide mentoring, coaching, and positive outcomes for employees, peers, and overall operations
Attend team and department meetings, trainings, and other job specific events as required
Adhere to established internal regulations regarding Department of Labor, HIPAA, ERISA and department and company policies and procedures
Complete HIPAA training and trainings assigned by quality team monthly/annually; follow PHI guidelines
Complete duties in accordance with scope of licensure and certifications held or requested
Other duties as assigned by the Manager or Senior Manager
Qualification
Required
A nursing degree or diploma from an accredited college, university, or school of nursing
3 years' experience in a clinical role with responsibilities for direct patient care
Experience in Utilization Review Services, Case Management, or transferable clinical experience and skills
Experience mentoring or managing a team of clinical or non-clinical staff
Experience working in a utilization review role
Knowledge and ICD and CPT codes
An active, current, and unrestricted Compact Registered Nurse License
Must maintain CEUs as required by applicable State Board(s) of Nursing and required certifications
Ability to work independently in a home office environment
Computer skills which include proficiency in Microsoft Outlook, Word, Excel, and PowerPoint, as well as navigation utilizing the internet
Ability to resolve problems independently and demonstrate ability to multi-task
Strong verbal and written communication skills
Strong presentation skills
Ability to demonstrate a commitment to building new skills and fostering a positive work environment
Preferred
Bachelor's degree in nursing preferred but not required
Experience working in a URAC accredited program preferred
Benefits
Multiple Health plan options
Company paid employee premiums for disability and life insurance
Parental Leave Policy
20 days PTO to start / 10 Paid Holidays
Tuition reimbursement
401k Company contribution
Company paid Short & Long term Disability plus Life Insurance
Professional development initiatives / continuous learning opportunities
Opportunities to participate in and support the company's diversity and inclusion initiatives
Company
Imagine360
Imagine360 is an integrated health plan addressing one of the greatest challenges on behalf of self-funded employers: healthcare costs are harming the bottom line, they're increasingly unaffordable for employees, and the experience remains poor.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Jeff Bak
President & CEO
Recent News
bloomberglaw.com
2025-08-26
2025-07-31
Company data provided by crunchbase