Remote Supervisor of Utilization of Management (RN) – NY, NJ, CT

Supervisor, Utilization Management (LTSS / MLTC)

Location: Tri-State Area (NY, NJ, CT)

Schedule: Monday–Friday, 9:00 AM – 5:00 PM (flexibility required)

Work Model: Primarily remote with occasional in-office requirements

Overview

We are seeking an experienced Supervisor of Utilization Management with a strong background in Long-Term Support Services (LTSS) and Managed Long-Term Care (MLTC). This individual will oversee day-to-day UM operations, lead a clinical team, and ensure quality, compliance, and cost-effective care delivery. This is a leadership role requiring a balance of clinical expertise, operational oversight, and team management.

Key Responsibilities

• Supervise and support a team of clinical staff and coordinators (approximately 15+ direct reports)
• Oversee all utilization management activities for LTSS services
• Ensure appropriate application of clinical guidelines (e.g., InterQual) and regulatory standards
• Monitor and drive productivity metrics, including volume of UM reviews and equitable workload distribution
• Lead cost-saving initiatives while maintaining quality of care and compliance
• Conduct audits, file reviews, and team meetings
• Support clinical decision-making and escalate issues as needed
• Collaborate with care management and cross-functional teams
• Ensure adherence to Medicaid and/or Medicare guidelines and benefit structures

Required Experience and Qualifications

• Minimum 2+ years of utilization review experience within a managed care organization or health plan
• Minimum 3+ years of supervisory or management experience in healthcare
• Strong experience in LTSS / MLTC, including clinical assessments and UM review processes
• Background in care management, utilization management, and productivity oversight
• Knowledge of Medicaid and/or Medicare regulations
• Experience applying InterQual or other evidence-based clinical guidelines
• Strong organizational, communication, and leadership skills
• Ability to manage multiple priorities and drive team performance

Preferred Experience

• Recent experience in discharge planning
• Recent experience in precertification
• Background in home care, hospital settings, or UAS assessments

Education and Licensure

• BSN required; advanced degree preferred
• Current, unrestricted New York State RN license

Additional Details

• Role includes a mix of administrative, clinical, and leadership responsibilities
• Requires someone who can lead an experienced team and maintain a steady, solutions-oriented approach
• Immediate need with onboarding aligned to upcoming orientation schedules