Utilization Review Manager

📋 Description

• Lead and manage the centralized Virtual Utilization Management program, ensuring clinical and
• Oversee utilization management processes covering inpatient and observation/outpatient
• Develop annual utilization management work plans aligned with strategic priorities and departmental
• Provide operational leadership and resources to virtual utilization management teams while
• Partner with hospital-based utilization management leaders, physician advisors, physicians, nurse
• Develop and implement strategies to reduce inappropriate denials, improve appeal outcomes, address

🎯 Requirements

• Associate degree in Nursing is required; a Bachelor’s degree in Nursing is preferred.
• Current unrestricted nursing license in the state of residence.
• MCG certification is required within six months of hire.
• Significant experience in utilization management, clinical review, denials and appeals, care
• Strong knowledge of MCG or other recognized medical-necessity criteria and their application in
• Broad understanding of insurance requirements, Medicare and Medicaid regulations, and applicable

🎁 Benefits

• Full-time, remote position with nationwide eligibility for U.S.-based candidates.
• Base salary range of $92,400 to $138,600, depending on experience and other job-related factors.
• Bonus and incentive opportunities.
• Comprehensive healthcare and benefits package supporting physical, emotional, and financial
• Paid time off and retirement benefits.
• Professional development opportunities and paid certifications relevant to your field.