Supervisor, Acute & Post-Acute Utilization Management

Job Category
:
Acute & Post-Acute Nurse Reviewer

Requisition Number
: SUPVA
001425

• Posted :
  October 20, 2026
• Full-Time
• Hybrid

Showing 1 location

Cleveland, OH 44144, USA

Medical Mutual employees must submit their applications through MySource.

Note:
This is a hybrid position located in Brooklyn, OH, with a three-day per week onsite requirement.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Job Summary:

Supervises assigned utilization staff. Ensures utilization staff appropriately apply medical necessity guidelines in making authorization determinations for inpatient admissions, concurrent, and retrospective reviews in collaboration with physician reviewers. Oversees processes to support evidence-based discharge planning so that patients have a safe and timely transition to next level of care.

Responsibilities:

• Supervises daily operations of assigned utilization staff. Provides leadership and change management to improve retention, efficiency, and quality outcomes. Fosters a transparent, high-performance culture through clear goals, performance feedback, and effective communication.
• Facilitates interdisciplinary collaboration for utilization management and discharge planning.
• Supports onboarding, training, coaching, and professional development. Applies evidence-based criteria and standards to support quality utilization management and discharge planning.
• Ensures that utilization staff appropriately gather the requisite data and information to enter authorizations. Tracks, trends and monitors the accuracy of data and timeliness of authorization decisions. Monitors designated reports to ensure internal controls are effective. Drives towards solutions that support departmental goals.
• Evaluates individual and team performance against established targets; motivates staff to meet departmental and organizational goals related to utilization, cost, quality and productivity targets; accountable for the team’s overall results as well as driving employee engagement as measured by employment surveys.
• Assists Manager in coordinating and facilitating system processes with providers, partners, vendors, and subcontractors as necessary.
• Ensures compliance with company policy and procedure, as well as state and federal rules and regulations and accreditation standards.
• Performs other duties as assigned.

Qualifications:

Education and Experience:

• Graduate of a registered nursing program approved by the Ohio State Nursing Board. Bachelor of Science in Nursing or Healthcare Administration preferred.
• 7 years or more progressive experience as a Registered Nurse (RN) in health insurance utilization review or case management, or equivalent relevant RN experience in a clinical practice.
• Relevant experience leading teams or projects.

Professional Certification(s):

• Registered Nurse with current Ohio unrestricted license required.
• Lean Six Sigma Yellow Belt preferred.

Technical Skills and Knowledge:

• Intermediate proficiency in Microsoft Office and web-based applications.
• Knowledge of healthcare delivery systems, managed care operations, health insurance benefits, and network design.
• Knowledge of medical terminology, coding, and claims management, including ICD-10, CPT, and HCPCS.
• Knowledge of HIPAA and applicable regulatory requirements.
• Knowledge of patient care continuums, expected outcomes, and community-based resources.
• Ability to analyze data, identify root causes, and apply continuous process improvement methodologies.
• Knowledge of Lean Six Sigma principles preferred.
• Ability to manage multiple priorities, solve complex problems, and adapt in a fast-paced environment.
• Ability to lead teams and facilitate change.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio…