UTILIZATION AND HEALTH PROGRAMS SUPERVISOR

We are looking for Utilization and Health Programs Supervisor to lead preventive health programs and utilization management initiatives. This role ensures appropriate use of medical benefits, supports cost efficiency, and drives customer service excellence through data-driven healthcare strategies.

Key Responsibilities

• Supervise wellness programs, health education activities, and chronic care initiatives
• Oversee utilization review to ensure medical necessity, appropriateness, and cost-effectiveness
• Monitor hospital and outpatient utilization trends and recommend control measures
• Coordinate with Medical, Provider Network, Claims, and Customer Service teams
• Manage staff performance, coaching, training, and process improvements
• Handle utilization-related complaints and support resolution of denied claims
• Prepare utilization, wellness, and performance reports for management

Qualificat...