Utilization Management (UM) Operations Supervisor

Utilization Management (UM) Operations Supervisor

Work Set-up: Onsite - Potential to WFH after training

Location: Valero, Makati City
Schedule: Graveyard | Shifting Hours

Position Summary

The Utilization Management (UM) Operations Supervisor is responsible for overseeing the daily operations of the Utilization Management administrative support team. This role provides leadership, coaching, workload management, and performance oversight to ensure authorization requests, referrals, fax intake, and administrative utilization management activities are completed accurately, efficiently, and within established service level agreements.

The Supervisor works collaboratively with Quality Assurance, Training, Workforce Management, and client leadership to drive operational performance while maintaining compliance with client policies and regulatory requirements.

This is a non-clinical leadership position. The Supervisor does not perform medical necessity reviews, approve or deny services, or perform duties requiring clinical licensure.

Essential Duties & Responsibilities

Team Leadership

• Supervise the daily activities of UM Coordinators.


• Monitor attendance, productivity, and schedule adherence.


• Conduct coaching sessions and performance reviews.


• Provide ongoing guidance and mentorship.


• Foster employee engagement and accountability.

Operations Management

• Monitor authorization queues and workload distribution.


• Ensure timely processing of authorization and referral requests.


• Monitor turnaround time (TAT) compliance.


• Coordinate staffing to meet operational demands.


• Escalate workflow issues appropriately.

Performance Management

• Track team KPIs and productivity metrics.


• Analyze operational performance trends.


• Develop action plans to improve performance.


• Conduct regular one-on-one meetings.


• Address performance issues in partnership with HR when necessary.

Quality & Compliance

• Ensure compliance with SOPs and regulatory requirements.


• Partner with QA to improve quality scores.


• Monitor adherence to documentation standards.


• Support audit readiness.


• Reinforce HIPAA compliance.

Client & Cross-Functional Collaboration

• Coordinate with licensed clinical teams regarding workflow issues.


• Partner with Training to support onboarding and upskilling.


• Work with Workforce Management to balance staffing.


• Communicate operational updates to leadership.


• Participate in client meetings when required.

Reporting

• Prepare operational reports.


• Monitor service levels.


• Report productivity and quality metrics.


• Identify risks and recommend solutions.

Process Improvement

• Support workflow optimization.


• Recommend operational improvements.


• Assist in implementation of new client processes.


• Participate in special projects.

Required Qualifications

• High School Diploma required; Bachelor's degree preferred.


• Minimum of 3–5 years of experience in healthcare operations, utilization management, prior authorization, claims, provider services, or managed care.


• Minimum of 1–2 years of leadership or supervisory experience.


• Strong knowledge of healthcare payer operations.


• Knowledge of medical terminology.


• Excellent leadership, coaching, and communication skills.


• Strong analytical and organizational abilities.


• Intermediate to advanced Microsoft Office skills.

Preferred Experience

Experience with:

• Utilization Management Operations


• Prior Authorization


• Referral Management


• Managed Care


• Medicare


• Medicaid


• Healthcare Operations Leadership


• Workforce Management


• Performance Coaching


• KPI Management


• Healthcare BPO Operations

Key Performance Indicators (KPIs)

• Team productivity


• Authorization turnaround time (TAT)


• Queue aging


• Schedule adherence


• Attendance


• Quality audit scores


• SLA compliance


• Employee engagement


• Attrition


• Coaching completion


• Client satisfaction

Work Arrangement: This is a full-time position that requires reporting to the office with a possibility of remote work set-up after successful completion of training. However, please note that this is a performance-based role, and the company reserves the right to require employees to report onsite at any time based on business needs, performance evaluations, operational requirements. Flexibility to transition to an office-based setup when necessary is expected.

Additional Benefits:

• Comprehensive HMO Coverage - Medical & Dental


• HMO coverage on Day 1 plus 1 dependent

COMPANY OVERVIEW:

ImageNet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. ImageNet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers. 

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers.  The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually.  The company has also developed an innovative workflow technology platform, Jetstream TM, to help with traceability, governance and automation of claims operations for its clients.

ImageNet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.