Utilization Review Supervisor

Responsibilities

• Plans, assigns, and directs the work of the Utilization Review team for all InterMed offices, including day‑to‑day operational oversight.
• Determines appropriate caseloads that allow for timeliness of requests and productivity that meets expectations.
• Provides ongoing advice, mentoring, coaching, counseling, and performance feedback to assigned staff.
• Completes performance reviews for all personnel within the assigned unit in a timely manner.
• Deals quickly and decisively with personnel issues as they arise; keeps the supervisor informed on the need for, or progress of, corrective action.
• Authorizes time‑off requests to ensure coverage necessary to maintain service guidelines.
• Performs weekly audits of more than 10% of reviews per UR Nurse to validate accuracy and completeness of the utilization review process, and conducts comparable periodic audits of Medical Management Coordinator work product.
• Serves as InterMed's compliance officer, ensuring compliance with state and URAC regulations.
• Participates as an active member of InterMed's Quality Management Program Committee, including quarterly meetings to discuss program improvements, measurements, assessments, and compliance.
• Maintains awareness of potential compromise to a patient's safety on each review and refers concerns to the proper authority.
• Requires comprehensive knowledge of Utilization Review guidelines in the California Labor Code and other states as needed.
• Works with the Medical Director to ensure compliance with Utilization Review guidelines.
• Oversees training of new staff on computer systems and on UR policies and procedures.
• Provides training for Intercare claims team at various locations to ensure timely and accurate workflow.
• Exhibits a knowledgeable and helpful attitude and projects a professional image on behalf of InterMed and Intercare.
• Fosters teamwork and cooperation between UR staff and other departments at InterMed, Intercare, and client organizations.
• Notifies the supervisor of potential client issues and works toward resolution.
• Assists with the implementation of new accounts, with input from account management, and supports staff compliance with client service instructions.
• Works effectively with peers across departments, demonstrating professionalism, respect, and a team‑oriented approach.
• Uses plain language to communicate, in writing and verbally, with injured workers, claims examiners, and clients.
• Maintains production performance and savings reports for management review.
• Leverages AI and office productivity tools to support project management and reporting workflows.
• Handles other duties and tasks as assigned by leadership.

Requirements

• Minimum of three years of clinical experience.
• Minimum of three years of leadership or supervisory experience.
• Minimum of one year of California Workers' Compensation Utilization Review experience, including working knowledge of the California Workers' Compensation Labor Code and regulations, and other states as needed.
• Progressive technical experience demonstrating sound judgment and discretion, with the ability to provide guidance on complex cases.
• Current, unrestricted RN or LVN license in the state in which the employee resides.