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Weekend Supervisor Utilization Management Jobs in Ohio

Majestic Care

Weekend Supervisor RN

Mason, OH · On-site

) Weekend Supervisor Nurse, RN Schedule includes Fridays, Saturdays & Sundays Majestic Care of XXXXX ... Manage area of responsibility with the goal of achieving and maintaining the highest quality of ...

Ohio Living

Nursing Weekend Supervisor

Powell, OH · On-site

Participates in the Manager On Duty program. Effectively communicate information pertaining to the ... Notify your supervisor or the Clinical Director if you observe a change in a resident's condition.

Journey

Weekend Supervisor, RN

Chardon, OH · On-site

As a Weekend Supervisor, you'll oversee nursing services for your assigned unit, ensuring top ... They're not just managers; they're passionate advocates for their communities. They understand the ...

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Weekend Supervisor Utilization Management information

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 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 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 most commonly searched types of Supervisor Utilization Management jobs in Ohio? The most popular types of Supervisor Utilization Management jobs in Ohio are:
What are popular job titles related to Weekend Supervisor Utilization Management jobs in Ohio? For Weekend Supervisor Utilization Management jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Weekend Supervisor Utilization Management jobs in Ohio look for? The top searched job categories for Weekend Supervisor Utilization Management jobs in Ohio are:
What cities in Ohio are hiring for Weekend Supervisor Utilization Management jobs? Cities in Ohio with the most Weekend Supervisor Utilization Management job openings:
Weekend Supervisor Utilization Management jobs near you
Infographic showing various Weekend Supervisor Utilization Management job openings in Ohio as of June 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.
Supervisor, Prior Authorization Utilization Management

Supervisor, Prior Authorization Utilization Management

Medical Mutual of Ohio

Cleveland, OH • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

Medical Mutual of Ohio rating

9.4

Company rating: 9.4 out of 10

Based on 15 frontline employees who took The Breakroom Quiz

13th of 261 rated insurance

Job description

Medical Mutual employees must submit their applications through MySource.
This is a hybrid-remote role based out of the Brooklyn, OH office, with employees expected to work onsite on designated in-office days each week.
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
Job Summary:
Supervises prior authorization utilization review nurses ensuring they appropriately apply medical necessity guidelines in making authorization determinations for preservice procedures and surgeries, in collaboration with physician reviewers. Oversees processes to support evidence-based guidelines, Corporate Medical Policies and other decision support tools to ensure comprehensive cost-effective care for members.
Responsibilities:
  • Supervises daily operations of assigned Prior Authorization Nurse Reviewers. Ensures appropriate use of staff resources to facilitate accurate and timely utilization management decisions in collaboration with physician reviewers.
  • Supports staff onboarding, training, and professional development including maintenance of current knowledge of approved criteria and evidence-based practice to support the delivery of high quality, efficient utilization management authorization determinations
  • Ensures that staff appropriately gather the requisite data and information to enter authorizations and tracks and monitors the accuracy and timelines of data entered
  • Evaluates the quality of individual and group performance to ensure that that team is meeting departmental and organizational goals related to utilization, cost, quality and productivity targets.
  • Ensures compliance with company policy and procedure as well as state and federal rules and regulations and accreditation standards.
  • Assists management in coordinating facility system process with providers, partners, vendors, and subcontractors as necessary
  • Performs other duties as assigned

Qualifications:
Education and Experience:
  • Graduate of a registered nursing program approved by the Ohio State Nursing Board. Bachelor of Science in Nursing preferred.
  • 7 years progressive experience as a Nurse Reviewer in health insurance prior authorization or clinical appeals, or equivalent relevant RN experience in a clinical practice
  • Relevant experience leading teams or projects (formally or informally)

Professional Certification(s):
  • Registered Nurse with current State of Ohio unrestricted license.

Technical Skills and Knowledge:
  • Intermediate Microsoft Office skills and proficiency navigating windows and web-based systems.
  • Knowledge of medical terminology/coding managed care processes
  • Knowledge of and the ability to apply fundamental concepts related to HIPAA compliance and related regulations
  • Knowledge of disease continuums expected patient outcomes and community services available
  • Strong knowledge of clinical claim management including ICD 10, CPT and HCPCS code
  • Strong knowledge of health insurance benefits and network plan designs

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:
A Great Place to Work:
  • We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
  • Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
  • On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
  • Discounts at many places in and around town, just for being a Medical Mutual team member.
  • The opportunity to earn cash rewards for shopping with our customers.
  • Business casual attire, including jeans.

Excellent Benefits and Compensation:
  • Employee bonus program.
  • 401(k) with company match up to 4% and an additional company contribution.
  • Health Savings Account with a company matching contribution.
  • Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
  • Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
  • Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
  • After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:
  • Career development programs and classes.
  • Mentoring and coaching to help you advance in your career.
  • Tuition reimbursement up to $5,250 per year, the IRS maximum.
  • Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:
Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.
There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.
We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
#LI-CS1 #LI-HYBRID
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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