What are the responsibilities and job description for the Prior Authorization RN Supervisor position at LSMA Management, Inc.?
Description
JOB SUMMARY
The Prior Authorization RN Supervisor provides clinical leadership and operational oversight for the Prior Authorization function within Medical Management. This role ensures the timely, accurate, and compliant review of authorization requests in accordance with CMS regulations, NCQA standards, applicable health plan requirements, and evidence-based clinical guidelines (e.g. Milliman Care Guidelines).
The RN Supervisor oversees Registered Nurses, LVNs, and Prior Authorization Coordinators, provides clinical decision support for complex cases; performs and delegates utilization review activities, ensures escalation to Medical Directors as appropriate; and partners with the UM Manager and health plans to support quality of care, regulatory compliance, and efficient authorization workflows.
Requirements
MINIMUM & PREFERRED QUALIFICATIONS
Education/Training
Minimum: Graduate of an accredited Registered Nursing program.
Preferred: Bachelor’s degree in Nursing or related field. Formal training or experience in utilization management, prior authorization, or medical management.
Experience
Minimum: 3 years of clinical nursing experience. Prior experience in utilization review, prior authorization, or managed care.
Preferred: Supervisory or lead experience in a UM or Medical Management setting. Experience in multi-specialty or delegated health plan environments.
Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.
Certification(s)
Current State Registered Nursing License
Preferred: CCM, CPUR, or similar UM certification
Skills, Knowledge & Abilities
JOB SUMMARY
The Prior Authorization RN Supervisor provides clinical leadership and operational oversight for the Prior Authorization function within Medical Management. This role ensures the timely, accurate, and compliant review of authorization requests in accordance with CMS regulations, NCQA standards, applicable health plan requirements, and evidence-based clinical guidelines (e.g. Milliman Care Guidelines).
The RN Supervisor oversees Registered Nurses, LVNs, and Prior Authorization Coordinators, provides clinical decision support for complex cases; performs and delegates utilization review activities, ensures escalation to Medical Directors as appropriate; and partners with the UM Manager and health plans to support quality of care, regulatory compliance, and efficient authorization workflows.
Requirements
MINIMUM & PREFERRED QUALIFICATIONS
Education/Training
Minimum: Graduate of an accredited Registered Nursing program.
Preferred: Bachelor’s degree in Nursing or related field. Formal training or experience in utilization management, prior authorization, or medical management.
Experience
Minimum: 3 years of clinical nursing experience. Prior experience in utilization review, prior authorization, or managed care.
Preferred: Supervisory or lead experience in a UM or Medical Management setting. Experience in multi-specialty or delegated health plan environments.
Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.
Certification(s)
Current State Registered Nursing License
Preferred: CCM, CPUR, or similar UM certification
Skills, Knowledge & Abilities
- Strong clinical assessment and decision-making skills.
- Ability to interpret medical records, clinical guidelines, and regulatory requirements.
- Knowledge of ICD-10, CPT, and HCPCS coding.
- Excellent verbal and written communication skills.
- Demonstrated leadership, coaching, and conflict-resolution abilities.
- Proficiency with Microsoft Office (Word, Excel, Outlook, PowerPoint) and electronic UM systems.
- Strong organizational skills with the ability to prioritize and manage multiple deadlines.