Lead Utilization Management: Denial Prevention & Coaching

WVU Medicine; Northern (KY); Hybrid; USD 90,000 - 120,000; Full time

Job summary

WVU Medicine in the United States is seeking a Lead Utilization Management Coordinator to drive strategic oversight, execution, and denial mitigation for timely authorizations and optimized reimbursement. You will mentor UM coordinators, partner with Physician Advisors and Clinical Appeals, and lead process improvements as an SME for UM.

The role emphasizes proactive denial-prevention solutions, educational initiatives for staff, and collaboration across revenue cycle and clinical care to ensure

Qualifications

• Current Registered Nurse license issued by the state in which services will be provided or current multi-state RN license through the Enhanced NLC.
• Four (4) years clinical experience in a hospital setting.
• Five (5) years Utilization Review and/or Clinical Appeals and/or case management experience.

Responsibilities

• Coaching and mentoring team members; identify skill gaps; provide real-time feedback and track action items.
• Monitor day-to-day operations; ensure deadlines and staffing coverage.
• Produce and communicate performance improvement opportunities; ensure quality assurance and SOP adherence.
• Act as SME: respond to staff questions; orient new staff; support education and process initiatives.
• Assess referred concurrent denials to determine next steps: peer-to-peer, billing status changes, or clinical information requests; refer cases as needed.

Skills

Verbal and written communication

Interpersonal skills

Attention to detail

Medical terminology

Payor concepts

Computers

Customer service

Education

RN license (state or multi-state eNLC)

Bachelor's Degree in Nursing

Job description

WVU Medicine in the United States is seeking a Lead Utilization Management Coordinator to drive strategic oversight, execution, and denial mitigation for timely authorizations and optimized reimbursement. You will mentor UM coordinators, partner with Physician Advisors and Clinical Appeals, and lead process improvements as an SME for UM.

The role emphasizes proactive denial-prevention solutions, educational initiatives for staff, and collaboration across revenue cycle and clinical care to ensure