Also referred to as:
Healthcare Utilization Review Supervisor
Requirements and Responsibilities
Medical Utilization Review Supervisor supervises the team responsible for evaluating proposed and/or delivered healthcare services to determine if the services meet established health plan coverage guidelines. Receives, reviews, and acts on pre-authorization requests from service providers for medical procedures, treatments, admissions, and medications. Being a Medical Utilization Review Supervisor reviews patient and clinical information to ensure compliance with established utilization review guidelines. Refers more complex requests and those that need clinical review to a medical reviewer. Additionally, Medical Utilization Review Supervisor may require a bachelor's degree. Typically reports to a manager. The Medical Utilization Review Supervisor supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/production environments. Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. To be a Medical Utilization Review Supervisor typically requires 3-5 years experience in the related area as an individual contributor. Thorough knowledge of functional area and department processes.
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