Healthcare Utilization Lead — Outcomes & Efficiency

Careerwebsite; Billings (MT); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Careerwebsite in Billings, MT seeks a Manager of Utilization Review to oversee cost-effective use of healthcare resources and improve patient outcomes.

The role leads a team, collaborates with medical staff, ensures regulatory compliance, analyzes utilization data, and partners with payers to secure timely reimbursement. Bachelor’s in Nursing and Montana RN license required; 5 years clinical experience; strong leadership.

Qualifications

• Bachelor's degree in nursing required.
• 5 years of experience in a clinical setting.
• Current Montana RN license.

Responsibilities

• Oversee the Utilization Review process to ensure cost-effective use of healthcare resources.
• Develop and implement utilization management strategies and protocols.
• Collaborate with medical staff to evaluate medical necessity and treatment plans.
• Lead and mentor a team of Utilization Review Specialists.
• Analyze utilization data and trends to identify opportunities for efficiency.
• Monitor provider performance and implement corrective action plans.
• Stay updated on regulations, guidelines, and technologies in utilization management.
• Maintain documentation to ensure compliance.
• Collaborate with payers to ensure timely reimbursement.
• Participate in quality improvement initiatives with the Quality Management team.

Skills

Utilization management

Leadership

Data analysis

Regulatory compliance

Team mentoring

Healthcare operations

Education

Bachelor's Degree in Nursing

Tools

Healthcare IT systems

Job description

Careerwebsite in Billings, MT seeks a Manager of Utilization Review to oversee cost-effective use of healthcare resources and improve patient outcomes.

The role leads a team, collaborates with medical staff, ensures regulatory compliance, analyzes utilization data, and partners with payers to secure timely reimbursement. Bachelor’s in Nursing and Montana RN license required; 5 years clinical experience; strong leadership.