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Weekend Supervisor Utilization Management Jobs in New York

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Weekend Supervisor Utilization Management information

What does a weekend supervisor in utilization management do?

A Weekend Supervisor in Utilization Management oversees the review and coordination of patient care services during weekends to ensure appropriate use of healthcare resources. They manage a team of utilization review staff, ensure compliance with policies, and facilitate communication between healthcare providers and insurance companies. Their role is critical in making timely decisions about patient admissions, continued stays, and discharges, focusing on quality care and cost efficiency. They also handle escalations and provide support to staff working outside of regular business hours.

What are the primary challenges a weekend supervisor in utilization management faces, and how can they be addressed?

Weekend Supervisors in Utilization Management often encounter challenges such as limited staff availability, high patient volume, and the need for rapid decision-making with less direct access to physicians or ancillary services. To address these, strong organizational skills, proactive communication, and the ability to prioritize urgent cases are essential. Supervisors should foster a collaborative atmosphere, leverage digital tools for efficient workflow, and ensure clear escalation protocols for complex cases, all while maintaining regulatory compliance and quality patient care.

What are the key skills and qualifications needed to thrive as a weekend supervisor in utilization management, and why are they important?

To thrive as a Weekend Supervisor Utilization Management, you need a comprehensive understanding of clinical guidelines, utilization review processes, and healthcare regulations, typically supported by a nursing degree (RN) or related clinical licensure. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of relevant accreditation standards (such as URAC or NCQA) are essential. Strong leadership, decision-making, and effective communication skills help navigate team dynamics and complex case reviews during weekend shifts. These skills ensure efficient resource management, compliance with healthcare standards, and consistent quality of care even outside regular business hours.

What is the difference between Weekend Supervisor Utilization Management vs Weekend Utilization Review Coordinator?

AspectWeekend Supervisor Utilization ManagementWeekend Utilization Review Coordinator
CredentialsTypically requires a healthcare-related license or certification (e.g., RN, LPN, or case management certification)Often requires similar healthcare credentials, such as RN or case management certification
Work EnvironmentSupervises utilization management staff, oversees case reviews, and ensures compliance during weekendsPerforms case reviews, evaluates medical necessity, and coordinates utilization decisions during weekends
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance providers, healthcare organizations

The main difference is that the Weekend Supervisor Utilization Management role involves supervising staff and managing utilization processes, while the Weekend Utilization Review Coordinator focuses on conducting case reviews and making utilization decisions during weekends. Both roles require healthcare credentials and operate within similar environments, but their responsibilities differ in scope and leadership level.

What are the most commonly searched types of Supervisor Utilization Management jobs in New York?

The most popular types of Supervisor Utilization Management jobs in New York are:

What are popular job titles related to Weekend Supervisor Utilization Management jobs in New York?

For Weekend Supervisor Utilization Management jobs in New York, the most frequently searched job titles are:

What job categories do people searching Weekend Supervisor Utilization Management jobs in New York look for?

The top searched job categories for Weekend Supervisor Utilization Management jobs in New York are:

What cities in New York are hiring for Weekend Supervisor Utilization Management jobs?

Cities in New York with the most Weekend Supervisor Utilization Management job openings:

Weekend Supervisor Utilization Management jobs near you

Supervisor, Utilization Management Technician

Capital Rx

Manhattan, NY • On-site

$78K - $85K/yr

Other

Posted yesterday

New

Job description

About Judi Health

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.

Location: Hybrid (Local to Denver, CO, Charlotte, NC or NYC area)

Position Responsibilities:

  • Responsible for overseeing a group of prior authorization technicians and expanded responsibility forselectadministrative PA functions.
  • Work in conjunction with the pharmacy technician manager in analyzing available data and provide prior authorization staffing, workflow and system enhancement recommendations.
  • Support on-going training and coaching of utilization management pharmacy technicians.
  • Participate in the goal setting process and regularly review performance of direct reports, addressing performance and behavioral issues when needed.
  • Investigate/resolve escalated issues or problems from clients and providers.
  • Works withutilization managementmanager on other responsibilities, projects,implementationsand initiatives as needed.
  • Review pharmacy claims data for proactive outreach and intervention.
  • Maintain quality and productivity standards for all cases triaged while minimizing compliance risk.
  • Work with business and clinical partners as needed.
  • Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines.
  • Proactively obtains clinical information from prescribers, referral coordinators, andappropriate staffto ensure all aspects of clinical guidelines are addressed for pharmacist review.
  • Identify, document, and escalate provider concerns to the appropriate internal team including various members of the utilization management team.
  • Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions.
  • Effectively communicate issues and resolutions to members, pharmacy staff, providers, and appropriate internal stakeholders.
  • Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies.
  • Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast paced, startup environment.
  • Ability to work in a fast-paced environment with shifting priorities, and flexible schedules that may include weekends.
  • Abilityto work flexible schedules that includes an on-call weekendand holidayrotation.

Required Qualifications:

  • At least 1 year of Medicare experience, including working knowledge of policies and guidelines
  • Minimum 1 year of Medicare Prior Authorization and/or Medicare appeals experience
  • Demonstrated ability to communicate effectively and manage team priorities
  • Strong organizational and problem-solving skills
  • Active, unrestricted, National Certified Pharmacy Technician (CPhT) license required
  • Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
  • Strong clinical background required
  • Excellent communication, writing, and organizational skills
  • Ability to multi-task and collaborate in a team with shifting priorities

Preferred Qualifications:

  • 2+ years of leadership experience
  • Strong understanding of CMS regulations and payer requirements
  • 2+ years of PBM or Managed Care pharmacy experience
New York, NY Salary Range
$78,400—$85,000 USD
Denver, CO Salary Range
$78,400—$85,000 USD
Charlotte, NC Salary Range
$78,400—$85,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found athttps://www.judi.health/legal/privacy-policy.

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