Supervisor of Utilization Review - Pivotal Placement Services : Job Details

Supervisor of Utilization Review Nurse (Remote)

We are seeking a highly skilled and self-motivated professional to lead our Utilization Review (UR) department. This full-time, permanent opportunity is ideal for someone with a strong background in California Workers' Compensation and Utilization Review, and proven success in department leadership. The Supervisor will oversee daily operations, ensure compliance with regulatory standards, and foster a collaborative and high-performing team culture.

Supervisory Responsibilities:

• Serve in a supervisory capacity more than 50% of the time, including hiring, training, evaluating, disciplining, and managing personnel matters.
• Supervise daily activities and performance of UR staff.
• Research, develop, and deliver UR training materials; conduct training for UR staff, clients, and agents.
• Lead regular department meetings and maintain meeting records.
• Act as liaison between UR staff, other departments, and leadership to ensure efficient communication.
• Collaborate with Human Resources and leadership to ensure compliance with laws, regulations, policies, and best practices.
• Promote and maintain a constructive and healthy company culture through effective leadership.
• Troubleshoot and escalate staff issues appropriately.
• Participate in leadership activities and initiatives.
• Mentor new or developing UR staff to support professional growth.
• Conduct periodic audits of UR work for quality assurance and coaching.
• Ensure staff are trained to recognize and report SFTP or EDI errors affecting turnaround time or compliance.
• Work with operations and compliance teams to standardize workflows and improve UR efficiency.

Mandatory Skills and Qualifications:

• AZ, CA, CO, or TX Registered Nurse (RN) license
• 3+ years of experience in Workers' Compensation, Utilization Review, Utilization Management, or equivalent.
• 3+ years of supervisory experience.
• Prior experience with the URAC accreditation process.
• 2+ years of experience in quality management and improvement projects.
• Proven success in UR/UM department leadership.
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Teams, Outlook).
• Skilled in online databases, contact management systems, internet use, and file management.
• Strong general computer and technology proficiency.
• Excellent verbal and written communication skills.
• Superior presentation and public speaking abilities.
• Ability to work independently, analyze data, solve problems, and meet deadlines.
• Professional handling of sensitive and confidential information.
• Strong teamwork, collaboration, and leadership skills.
• Exceptional organizational, decision-making, and management capabilities.
• Deep understanding of professional client service standards.
• Typing speed of 45+ WPM.

Preferred Skills and Qualifications:

• Extensive knowledge of medical terminology.
• LVN, LPN, RN, MD, DC, or other relevant medical certifications/licenses.
• BS, BA, graduate, or professional degree(s).
• Prior experience in Workers' Compensation medical management, insurance claims, or medical authorization review.
• 5+ years of experience in quality management and improvement projects.

Benefits:

• Home office equipment provided
• Salary, monthly bonus, mileage reimbursement, and excellent comprehensive benefits, including Health Insurance and 401k

Who We Are

Headquartered in Central Florida, Pivotal Placement Services is a full-service national workforce solutions firm that specializes in placing healthcare professionals from staff to leadership with both clinical and non-clinical employers. Our Comprehensive and Customer Focused Workforce Solutions include, Right-to-Hire Contract Staffing, Direct Placement, and Managed Service Provider (MSP) / Vendor Managed Services (VMS) engagements nationally. Pivotal Placement Services is an Equal Opportunity Employer.