Medical Review/Utilization Review

Job Title: Medical Review/Utilization Supervisor

Location: New Jersey (Remote/Onsite as needed)
Employment Type: Full-Time

Position Overview:
Genesis Consulting Support is seeking a qualified and experienced Medical Review/Utilization Supervisor to oversee audit activities and ensure compliance with Medicaid and Medicare regulations. The Supervisor will lead and support medical review teams, provide quality oversight, and ensure consistent application of utilization review standards. This role plays a key part in maintaining audit integrity and ensuring adherence to state policies and procedures.

Key Responsibilities:

• Supervise and coordinate daily activities of Medical Review Auditors.

• Ensure audit protocols are followed in accordance with Medicaid regulations.

• Provide training, support, and performance evaluation for review staff.

• Collaborate with project leadership to improve audit quality and efficiency.

• Interpret and apply state Medicaid policies to audit processes.

Minimum Qualifications:

• A Bachelor’s degree in Nursing, Social Work, or Health Services.

• Must hold an active New Jersey Registered Nurse (RN) license.

• At least three (3) years of experience conducting Medicaid or Medicare audits.

• Recent supervisory experience in medical utilization review (UR).

• Demonstrated working knowledge of Medicaid provider audits.

• Proven ability to interpret State Medicaid regulations and policies effectively.

Preferred Skills:

• Strong leadership, communication, and organizational skills.

• Familiarity with MMIS and claims review systems.

• Ability to mentor and guide staff in a regulatory environment.

Placement Type:
Full-time | Contract | Hybrid work model may be available