RN Utilization Review Project Lead

Med-Metrix; Parsippany-Troy Hills, Northern (NJ, KY); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Med-Metrix seeks a Project Manager, Utilization Review to provide operational and analytical support to end-to-end UR clients. You will oversee implementation coordination, stakeholder management, and utilization data analysis with a focus on HIPAA compliant handling of PHI.

You will lead meetings, track deliverables, and support onboarding while driving data-driven decisions and project efficiencies across hospital UR processes.

Qualifications

• Active RN license required.
• 4+ years Healthcare compliance and utilization review experience required.
• Proficiency with data analysis tools and MCG and IQ application expertise required.
• End-to-end client or managed care operations experience.
• PowerBI or data visualization experience preferred.
• Proficiency in Microsoft Office Suite.
• Strong interpersonal skills, ability to communicate well at all levels of the organization.
• Strong problem solving and judgment with timely analyses.
• Excellent written and verbal communication skills required.

Responsibilities

• Prepare and participate in client review meetings (decks, data summaries, presentations).
• Track deliverables, timelines, and client escalations.
• Support client onboarding processes and operational handoffs.
• Analyze utilization data, case trends, and client performance metrics.
• Investigate clinical and operational issues for end-to-end clients.
• Prepare data-driven summaries and recommendations for leadership review.
• Lead ad-hoc projects for end-to-end clients as directed.
• Provide support on time-sensitive deliverables and client requests.
• Manage project timelines, resources, and stakeholder coordination.
• Serve as operational point of contact for end-to-end clients.
• Support escalation resolution and issue tracking.
• Contribute to operational efficiency improvements.

Skills

Data analysis tools

Interpersonal skills

Communication skills

Tools

PowerBI

MCG IQ

Microsoft Office

Job description

Med-Metrix seeks a Project Manager, Utilization Review to provide operational and analytical support to end-to-end UR clients. You will oversee implementation coordination, stakeholder management, and utilization data analysis with a focus on HIPAA compliant handling of PHI.

You will lead meetings, track deliverables, and support onboarding while driving data-driven decisions and project efficiencies across hospital UR processes.