Nurse Utilization Review Supervisor

About the role

The University of Miami seeks a Nurse Utilization Review Supervisor to lead the Case Management Department. This role combines supervisory duties with hands‑on utilization review and case management responsibilities, ensuring compliance with medical necessity standards and supporting patient care coordination.

Key responsibilities

• Analyze and distribute daily case assignments to staff and nursing supervisors.
• Oversee staff performance, conduct annual evaluations, and advise on disciplinary actions.
• Ensure compliance with utilization review initiatives, including InterQual® criteria and CMS two‑midnight rule.
• Assist Care Coordination staff with family or physician issues and facilitate resolution.
• Perform case management and utilization review duties as needed, maintaining a reduced patient load.
• Round on assigned floors to verify timely delivery of clinical and community services.
• Manage observation patient processes and verify appropriate placement.
• Collaborate with physicians on medical necessity and discharge planning.

Required profile

• Registered Nurse with experience in case management or utilization review.
• Demonstrated supervisory or leadership experience in a healthcare setting.
• Strong knowledge of medical necessity criteria, CMS regulations, and InterQual® standards.
• Ability to work collaboratively with multidisciplinary teams and managed‑care plans.

Required skills

• InterQual criteria software
• Electronic Medical Record (EMR) systems