RN UM Team Lead: Accelerate Care Decisions

Personify Health, Inc.; United States; Remote; USD 52,000 - 61,000; Full time

Benefits offered by this job

Competitive benefits

Paid Time Off

Mental health support

Retirement planning

Professional development

Job summary

Personify Health, Inc. seeks a RN UM Team Lead to coach reviewers, apply medical-necessity criteria, and keep documentation audit-ready for timely and compliant care decisions.

Schedule: Mon–Fri 8:00 AM–5:00 PM Pacific Time with rotating Saturday coverage; lead a team focused on reducing backlog while protecting member data and maintaining HIPAA standards. You’ll partner with providers, facilities, case management, appeals, and provider relations to move determinations and keep care moving.

Qualifications

• Active RN license.
• Experience in utilization management, clinical review, or case management.
• Background applying medical-necessity criteria and benefit plan interpretation in a healthcare payer or clinical review setting.

Responsibilities

• Set daily direction for your UM team and establish priorities.
• Coach reviewers on medical-necessity criteria and policy interpretation.
• Monitor workflow health, aging cases, and turnaround risk; flag barriers with a recommendation.
• Audit documentation quality for completeness and regulatory timeliness.
• Build reviewer capability with shadowing plans, job aids, and training.
• Resolve cross-team barriers with providers, facilities, Case Management, Appeals, and Provider Relations to keep determinations moving.
• Protect member data and HIPAA compliance; model ethical decision-making.
• Drive training completion and attestations on time.

Skills

UM platforms

Medical terminology

Remote collaboration tools

Education

Active RN license

Job description

Personify Health, Inc. seeks a RN UM Team Lead to coach reviewers, apply medical-necessity criteria, and keep documentation audit-ready for timely and compliant care decisions.

Schedule: Mon–Fri 8:00 AM–5:00 PM Pacific Time with rotating Saturday coverage; lead a team focused on reducing backlog while protecting member data and maintaining HIPAA standards. You’ll partner with providers, facilities, case management, appeals, and provider relations to move determinations and keep care moving.