Job Description

JOB TITLE: Nurse Supervisor, Utilization Review

SUPERSEDES: 01/24

FLSA: Exempt

JOB CODE: 9267

ISSUED: 01/2024

REVISED: 08/2025

BASIC FUNCTION AND RESPONSIBILITY

The Nurse Supervisor, Utilization Review provides technical and administrative direction to the staff performing utilization review functions to inpatient, observation, and outpatient in-bed encounters. This position supervises the day-to-day activities of the team by assigning workload, reviewing key performance indicators, and performing root cause analysis for process improvement.

ESSENTIAL FUNCTIONS

Oversees, coordinates, and monitors the daily operations of the Utilization Review team to support departmental objectives, including determining and coordinating appropriate levels of care, assessing medical necessity, facilitating communication with payors, and securing authorization for encounters.

Acts as a resource for direct reports by assisting in problem-solving and responding to questions related to Utilization Review operations. Serves as a subject matter expert to departmental staff, internal departments, and clinical teams. Models effective communication when interacting with direct reports, providers, and clinical staff across all service lines.

Participates in the development and implementation of effective policies, protocols, processes, and reports to improve and support utilization review operations. Ensures all activities align with regulatory and health plan requirements.

Measures and monitors key performance indicators for the department at both the team and individual levels. Provides timely feedback, conducts root cause analyses, and leads continuous improvement initiatives to advance utilization management effectiveness. Promotes team and employee engagement by facilitating or participating in team huddles to share updates, monitor daily workflow, address concerns, and implement countermeasures as needed.

Assists with departmental human resource functions, including candidate selection, orientation, and mentorship of new team members. Provides coaching, counseling, and professional development. Identifies needs for and conducts in-service training to improve review quality and disseminate information regarding regulatory or health plan changes.

Collaborates with other revenue cycle departments to enhance financial performance by reducing denials and write-offs and increasing collections.

Collaborates closely with physicians, clinical staff, and other departments to ensure accurate, timely, and compliant billing and reimbursement, escalating utilization review issues as needed.

9267h-NurseSupervisor,UtilizationReview08/11/2025

Develops, coordinates, and maintains daily staffing schedules to ensure the appropriate level of unit coverage and continuity of care.

Monitors time and attendance in alignment with MU Health Care policies and practices, ensuring accuracy of records and timely submittal or approval for payroll purposes.

May complete unit/department-specific duties and expectations as outlined in department documents.

KNOWLEDGE, SKILLS AND ABILITIES

Strong analytical and critical thinking skills.

Effective negotiator.

Ability to evaluate and investigate issues to determine effective resolution to avoid negative financial impact.

Excellent interpersonal, written, and verbal skills.

Ability to effectively communicate with a variety of individuals including physicians and payer representatives.

Experience with Cerner EMR and Utilization Review admission screening criteria.

SUPERVISION RECEIVED

Supervision is received from the Manager, Nursing Utilization Review.

SUPERVISION EXERCISED

Supervision is exercised over clinical and support staff.

REQUIRED QUALIFICATIONS

Bachelor of Science in Nursing degree.

Three (3) years of RN nursing experience.

Missouri Board of Nursing RN or Nurse Licensure Compact multi-state RN. When primary state of residency changes, compact state RNs must apply under new state of residency within thirty (30) days.

PREFERRED QUALIFICATIONS

Two (2) years of experience in first-level supervision of nurses, including registered nurses, or one (1) year of experience in the clinical instruction of nurses.

Two (2) years in the treatment of chronic and short-term medical and surgical inpatient problems.

Two (2) years of prior utilization review experience in an acute care hospital setting.

Additional license/certification requirements as determined by the hiring department.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met with or without reasonable accommodation. The performance of these physical demands is an essential function of the job. The employee may be required ambulate, remain in a stationary position and position self to reach and/or move objects above the shoulders and below the knees. The employee may be required to move objects up to 10 lbs.

PERFORMANCE EXPECTATIONS

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job; however, completion of these duties is a measure of successful performance. Employees of this job classification are subject to performance reviews. Basic function, responsibilities and characteristics duties may change at any time with or without notice.

SAFETY SENSITIVE STATUS

This position is considered safety sensitive.

This document is a general description of typical job duties, responsibilities and qualifications of employees holding the associated job title. Additional duties, specific qualifications and work emphasis may vary between individual positions.