Utilization Review Supervisor

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.

UTILIZATION REVIEW SUPERVISOR Rockford, Remote In this position you will be working with a team of independent and autonomous Intake Coordinators and Utilization Review Nurses to break down barriers and ensure quality and timely determinations are delivered to providers and members. In collaboration with your department manager and the Leadership Team, you will strive for continuous improvement and an excellent work-life balance to produce top-notch results.

Coordinating and providing care management and care that is timely, effective, efficient, equitable, safe, and member centered. Managing case assignments (outreach, documentation, case progression, and case closures), meeting reporting and documentation standards, and engaging in collaborative meetings with clients. Monthly attendance and coordination of UM/PHM Committee Meetings including material preparation, minutes, data collection and analysis, reporting and follow-up tasks. Training new and current employees with Preceptors. Re-education for audit fallouts. Assisting in creating, re-evaluating, and updating workflows/processes. Updating internal knowledge base and Confluence pages. Assisting in creation, re-evaluation, and analysis of necessary reporting, and identification of reporting opportunities. Attending and participating in virtual and in-person leadership meetings as necessary. Responsible for continued professional growth and education that reflects knowledge and understanding of current nursing care practice as outlined in the Illinois Nurse Practice Act. Other responsibilities as assigned, including assisting with payroll and monitoring FTO requests, as well as completing coaching and performance reviews with the team. Communication with IPA Administrators and Client Business Managers to ensure resolution of any concerns.