Utilization Review Supervisor

Job Description

Job Description

Description:

AvonRisk is the nation's leading specialty risk manager for self-insured organizations, uniting respected regional leaders in workers' compensation, liability, managed care, and risk management across 32 states. With nearly 700 professionals and brands including Intercare, InterMed, George Hills, and AS&G Claims Administration, we are a people-focused, operations-driven organization that prioritizes reasonable caseloads, strong training, collaborative teams, and expert support. We invest in tools and workflows that reduce friction—not increase volume—and create real career paths for professionals who want to grow into leadership. At AvonRisk, you are part of a team that values good judgment, curiosity, and accountability, and gives you the support to succeed.

This position is fully remote and reports to the Director of Clinical Services. Employees must be available to work Pacific time zone business hours regardless of their physical location.

Under administrative direction, the Utilization Review Supervisor is responsible for the overall work product of a Utilization Review team comprised of UR Nurses and Medical Management Coordinators. The role involves coaching and counseling, monitoring work performance to assure compliance with company standards and Labor Code rules and regulations, conducting performance evaluations, and instituting corrective action when appropriate.

Essential Duties and Responsibilities:

Team Leadership & Operations:

• 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.

Quality, Compliance, & Audit:

• 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.

Training & Development:

•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.

Client & Cross Functional Support:

• 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.

Reporting:

•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.

Competencies:

•Project Management — develops and coordinates project plans, communicates changes and progress, and completes projects on time and on budget.

• Change Management — develops workable implementation plans, communicates change effectively, builds commitment, and monitors transition results.

• Leadership — inspires and motivates others, influences actions and opinions effectively, accepts feedback, and provides vision to peers and subordinates.

• Managing People — includes staff in planning and decision-making, provides regular performance feedback, develops subordinates' skills, and fosters a quality focus.

• Analytical & Problem Solving — synthesizes complex information, identifies and resolves problems in a timely manner, and develops alternative solutions.

• Self-motivated with strong organizational, time-management, and multitasking skills, and the ability to adapt to changing priorities.

Qualifications:

Education and Experience:

• 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.

Certificates and Licenses:

• Current, unrestricted RN or LVN license in the state in which the employee resides.

Supervisory Responsibilities:

Directly supervises employees in the Managed Care Department, including UR Coordinators, UR Nurses, and Medical Management Coordinators. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws, including interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; and addressing complaints and resolving problems.

Compensation & Benefits:

Salary Range: $70,000–$90,000 annually.

The salary range listed is an estimate; actual compensation will be determined based on factors such as a candidate's experience, qualifications, skill set, and work location.

We take care of our people so they can take care of their work and their teams! AvonRisk offers a competitive, people-first benefits package designed to support your health, financial security, and career growth, including:

• Comprehensive medical, dental, and vision benefits

• Company contributions to HSA and FSA plans

• Employer-paid life and disability insurance

• 401(k) with company match

• Paid time off (PTO) and company-paid holidays

• Learning and development opportunities that support real career advancement

• Employee assistance resources and a supportive culture that values balance and wellbeing

We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.

Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.

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